Provider Demographics
NPI:1437247277
Name:NELSON, LINDA LEE (MSPA, CCC-A)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LEE
Last Name:NELSON
Suffix:
Gender:F
Credentials:MSPA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-6305
Mailing Address - Country:US
Mailing Address - Phone:509-962-9575
Mailing Address - Fax:509-962-5575
Practice Address - Street 1:601 N MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-6305
Practice Address - Country:US
Practice Address - Phone:509-962-9575
Practice Address - Fax:509-962-5575
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00001068237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WANE1748OtherREGENCE BLUESHIELD
WA5100/9772OtherGROUP HEALTH COOPERATIVE
WA9038514Medicaid
WA7061534Medicaid
WANE1748OtherREGENCE BLUESHIELD