Provider Demographics
NPI:1699979583
Name:LEE, MARY A (MACCCSLPL)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:A
Last Name:LEE
Suffix:
Gender:F
Credentials:MACCCSLPL
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:A
Other - Last Name:CRUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MACCCSLPL
Mailing Address - Street 1:3447 N SEELEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6113
Mailing Address - Country:US
Mailing Address - Phone:773-550-6987
Mailing Address - Fax:773-244-1364
Practice Address - Street 1:1640 N WELLS ST UNIT 103
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-6006
Practice Address - Country:US
Practice Address - Phone:773-550-6987
Practice Address - Fax:773-244-1364
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.005733235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist