Provider Demographics
NPI:1396573630
Name:LEE, JEAN KYUNG (MA)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:KYUNG
Last Name:LEE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1823 HICKS RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-1270
Mailing Address - Country:US
Mailing Address - Phone:708-787-3171
Mailing Address - Fax:
Practice Address - Street 1:1823 HICKS RD UNIT A
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-1270
Practice Address - Country:US
Practice Address - Phone:708-797-3171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional