Provider Demographics
NPI:1053085837
Name:BLACKSTOCK, LINDSAY BUECHTER
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:BUECHTER
Last Name:BLACKSTOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5153 LAKESPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-4405
Mailing Address - Country:US
Mailing Address - Phone:770-331-1319
Mailing Address - Fax:
Practice Address - Street 1:5871 GLENRIDGE DR STE 110
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5304
Practice Address - Country:US
Practice Address - Phone:678-527-3224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP010635235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist