Provider Demographics
NPI:1417198672
Name:LINGO, DENISE TUCKER (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:TUCKER
Last Name:LINGO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3249 WINTERHAWK DR
Mailing Address - Street 2:
Mailing Address - City:BIGFORK
Mailing Address - State:MT
Mailing Address - Zip Code:59911-6065
Mailing Address - Country:US
Mailing Address - Phone:406-871-7930
Mailing Address - Fax:
Practice Address - Street 1:3249 WINTERHAWK DR
Practice Address - Street 2:
Practice Address - City:BIGFORK
Practice Address - State:MT
Practice Address - Zip Code:59911-6065
Practice Address - Country:US
Practice Address - Phone:406-871-7930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1159235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist