Individual
MARISSA JOY LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
4212 CORAL PARK DR, BRUNSWICK, GA 31520
(912) 996-2069
(912) 265-0041
Mailing address
118 PEARL AVE N, DOUGLAS, GA 31533-4632
(912) 331-0846
(678) 792-4894
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP10135
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GA00590
CERTIFIED BASIC LIFE SUPPORT :CPR AND AED
GA
01
—
SLP10135
SPEECH PATHOLOGIST
GA
Enumeration date
09/05/2017
Last updated
07/12/2018
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