Provider Demographics
NPI:1518119940
Name:CHURCH, LINDA JEANNE (MS/CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:JEANNE
Last Name:CHURCH
Suffix:
Gender:F
Credentials:MS/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-2719
Mailing Address - Country:US
Mailing Address - Phone:518-584-2867
Mailing Address - Fax:518-584-2867
Practice Address - Street 1:225 LAKE AVE
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2719
Practice Address - Country:US
Practice Address - Phone:518-584-2867
Practice Address - Fax:518-584-2867
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005169235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist