Provider Demographics
NPI:1437678745
Name:KOLO, LYNSEY KATHERINE (MSP, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:LYNSEY
Middle Name:KATHERINE
Last Name:KOLO
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:MISS
Other - First Name:LYNSEY
Other - Middle Name:KATHERINE
Other - Last Name:KOLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSP, CCC-SLP
Mailing Address - Street 1:9731 COMMERCE CENTER CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-1400
Mailing Address - Country:US
Mailing Address - Phone:239-334-2500
Mailing Address - Fax:
Practice Address - Street 1:9731 COMMERCE CENTER CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-1400
Practice Address - Country:US
Practice Address - Phone:239-334-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA15468235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist