Provider Demographics
NPI:1710879721
Name:LEE, ADDISON
Entity type:Individual
Prefix:
First Name:ADDISON
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ADDISON
Other - Middle Name:
Other - Last Name:SHUMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1507 ALICE ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-4530
Mailing Address - Country:US
Mailing Address - Phone:912-614-7847
Mailing Address - Fax:
Practice Address - Street 1:277 N. BRUNSWICK ST.
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31546
Practice Address - Country:US
Practice Address - Phone:912-427-0447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET004304235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist