Provider Demographics
NPI:1487203097
Name:LIND, LISA MARGUERITE (MA CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARGUERITE
Last Name:LIND
Suffix:
Gender:F
Credentials:MA CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14727 15TH DR
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-2508
Mailing Address - Country:US
Mailing Address - Phone:718-746-0396
Mailing Address - Fax:
Practice Address - Street 1:14727 15TH DRIVE
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-2599
Practice Address - Country:US
Practice Address - Phone:718-746-0396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-06
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14147303235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY14147303OtherAMERICAN SPEECH-LANGUAGE HEARING ASSOCIATION