Provider Demographics
NPI:1467493643
Name:LIDDELL, LYNDA J (MS AUDIOLOGIST)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:J
Last Name:LIDDELL
Suffix:
Gender:F
Credentials:MS AUDIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:580 FAIRGROUNDS DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2413
Mailing Address - Country:US
Mailing Address - Phone:916-451-7837
Mailing Address - Fax:
Practice Address - Street 1:5342 DUDLEY BLVD
Practice Address - Street 2:AUDIOLOGY 126 VAOPC
Practice Address - City:MCCLELLAN
Practice Address - State:CA
Practice Address - Zip Code:95652-1012
Practice Address - Country:US
Practice Address - Phone:916-561-7470
Practice Address - Fax:916-561-7437
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2158231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist