Provider Demographics
NPI:1285196154
Name:LEE, REBEKAH ANNE
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:ANNE
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18603 E SWAN DR
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-5148
Mailing Address - Country:US
Mailing Address - Phone:602-881-8525
Mailing Address - Fax:
Practice Address - Street 1:1909 E RAY RD STE 9-244
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-8724
Practice Address - Country:US
Practice Address - Phone:480-382-6618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA117112355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZSLPA11711OtherARIZONA DEPARTMENT OF HEALTH SERVICES