Provider Demographics
NPI:1326149410
Name:LAUDERDALE, LINDA FRIEDMAN (M ED CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:FRIEDMAN
Last Name:LAUDERDALE
Suffix:
Gender:F
Credentials:M ED CCC-SLP
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:CURLEE
Other - Last Name:LAUDERDALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, CCC-SLP
Mailing Address - Street 1:75 OLD EDWARDS ROAD
Mailing Address - Street 2:
Mailing Address - City:ARNOLDSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30619-1903
Mailing Address - Country:US
Mailing Address - Phone:706-353-9600
Mailing Address - Fax:706-353-9600
Practice Address - Street 1:75 OLD EDWARDS ROAD
Practice Address - Street 2:
Practice Address - City:ARNOLDSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30619-1903
Practice Address - Country:US
Practice Address - Phone:706-353-9600
Practice Address - Fax:706-353-9600
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000407235Z00000X
GASLP000407235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGA LICENSE 000407OtherSPEECH,LANG, HEARING SERV