Provider Demographics
NPI:1497918577
Name:ORANGE, LYNNE KAULBACK (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:KAULBACK
Last Name:ORANGE
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 982
Mailing Address - Street 2:
Mailing Address - City:ATHOL
Mailing Address - State:ID
Mailing Address - Zip Code:83801-0982
Mailing Address - Country:US
Mailing Address - Phone:650-556-4225
Mailing Address - Fax:
Practice Address - Street 1:11111 E ARROYO LN
Practice Address - Street 2:
Practice Address - City:ATHOL
Practice Address - State:ID
Practice Address - Zip Code:83801-7808
Practice Address - Country:US
Practice Address - Phone:650-556-4225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16279235Z00000X
VA2202004958235Z00000X
ID4048235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist