Provider Demographics
NPI:1134492564
Name:BREIDENBACH, LYNDA (MS)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:
Last Name:BREIDENBACH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 BROADWAY ST STE 106
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-5257
Mailing Address - Country:US
Mailing Address - Phone:210-828-5583
Mailing Address - Fax:
Practice Address - Street 1:5800 BROADWAY ST STE 106
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-5257
Practice Address - Country:US
Practice Address - Phone:210-828-5583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11969235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist