Provider Demographics
NPI:1306201645
Name:FERNANDEZ, LYNDSIE RAE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LYNDSIE
Middle Name:RAE
Last Name:FERNANDEZ
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 1:14520 GREENBRIAR PL
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-6372
Mailing Address - Country:US
Mailing Address - Phone:954-303-1758
Mailing Address - Fax:
Practice Address - Street 1:14520 GREENBRIAR PL
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33325-6372
Practice Address - Country:US
Practice Address - Phone:954-303-1758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA14152235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist