Provider Demographics
NPI:1174655187
Name:BELFORD, LYNETTE MARIE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:MARIE
Last Name:BELFORD
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2341 LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1320
Mailing Address - Country:US
Mailing Address - Phone:570-326-7770
Mailing Address - Fax:
Practice Address - Street 1:2341 LINWOOD AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-1320
Practice Address - Country:US
Practice Address - Phone:570-326-7770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL004795L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013965420001Medicaid