Provider Demographics
NPI:1033493119
Name:MASTROENI, LINDSAY JO (BA)
Entity Type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:JO
Last Name:MASTROENI
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12574 N 151ST DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-9170
Mailing Address - Country:US
Mailing Address - Phone:623-218-6494
Mailing Address - Fax:
Practice Address - Street 1:12574 N 151ST DR
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-9170
Practice Address - Country:US
Practice Address - Phone:623-218-6494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA75012355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant