Provider Demographics
NPI:1457483463
Name:LYNDA J. MAZZOLA S-L PATHOLOGIST PC
Entity Type:Organization
Organization Name:LYNDA J. MAZZOLA S-L PATHOLOGIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAZZOLA
Authorized Official - Suffix:
Authorized Official - Credentials:CCC SLP
Authorized Official - Phone:207-377-2472
Mailing Address - Street 1:28 N HERITAGE WOODS LN
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:ME
Mailing Address - Zip Code:04364-3240
Mailing Address - Country:US
Mailing Address - Phone:207-377-2472
Mailing Address - Fax:
Practice Address - Street 1:28 N HERITAGE WOODS LN
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:ME
Practice Address - Zip Code:04364-3240
Practice Address - Country:US
Practice Address - Phone:207-377-2472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty