Provider Demographics
NPI:1417250275
Name:HIEBERT, LINDSEY ALANE (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:ALANE
Last Name:HIEBERT
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 S THOMPSON LOOP
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-2978
Mailing Address - Country:US
Mailing Address - Phone:928-600-2268
Mailing Address - Fax:
Practice Address - Street 1:125 E ELM AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3258
Practice Address - Country:US
Practice Address - Phone:928-779-1679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP7041235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist