Provider Demographics
NPI:1467075945
Name:PIPPEN, LYNSEY LUKE (EDD)
Entity Type:Individual
Prefix:DR
First Name:LYNSEY
Middle Name:LUKE
Last Name:PIPPEN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 HAWTHORNE TRL
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-3030
Mailing Address - Country:US
Mailing Address - Phone:985-381-2206
Mailing Address - Fax:
Practice Address - Street 1:505 HAWTHORNE TRL
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-3030
Practice Address - Country:US
Practice Address - Phone:985-381-2206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5654235Z00000X
CA29343235Z00000X
FL15516235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist