Provider Demographics
NPI:1164706115
Name:WILSON, LINDSAY (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3721 SW COQUINA COVE WAY APT 206
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-8172
Mailing Address - Country:US
Mailing Address - Phone:785-691-7901
Mailing Address - Fax:
Practice Address - Street 1:6011 SE TOWER DR
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-7615
Practice Address - Country:US
Practice Address - Phone:772-286-7895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 10460235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist