Provider Demographics
NPI:1316545676
Name:LEE, KRISTOPHER
Entity type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:
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 1:470 FROG POND RD
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:MO
Mailing Address - Zip Code:65746-7296
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:416 E CLINTON AVE
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:MO
Practice Address - Zip Code:65746-8938
Practice Address - Country:US
Practice Address - Phone:417-935-2287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018017877235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist