Provider Demographics
NPI:1306173133
Name:LEE, PETER A
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:A
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33608 SPRINGER RD
Mailing Address - Street 2:
Mailing Address - City:PHILOMATH
Mailing Address - State:OR
Mailing Address - Zip Code:97370-9718
Mailing Address - Country:US
Mailing Address - Phone:541-908-2466
Mailing Address - Fax:541-451-4902
Practice Address - Street 1:745 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-3209
Practice Address - Country:US
Practice Address - Phone:541-908-2466
Practice Address - Fax:541-451-4902
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-16
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORHAS-P-522132237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist