Provider Demographics
NPI:1477153104
Name:LEE, KARI IVERSON (SLP)
Entity type:Individual
Prefix:
First Name:KARI
Middle Name:IVERSON
Last Name:LEE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 24TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-8603
Mailing Address - Country:US
Mailing Address - Phone:360-676-6420
Mailing Address - Fax:360-676-4989
Practice Address - Street 1:1041 24TH ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-8603
Practice Address - Country:US
Practice Address - Phone:360-676-6420
Practice Address - Fax:360-676-4989
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL61088256235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist