Provider Demographics
NPI:1568724250
Name:PRESTEMON, LINDA LEE (CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LEE
Last Name:PRESTEMON
Suffix:
Gender:F
Credentials:CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 NICOLE DR UNIT E
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-3633
Mailing Address - Country:US
Mailing Address - Phone:630-788-6019
Mailing Address - Fax:
Practice Address - Street 1:273 NICOLE DR UNIT E
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-3633
Practice Address - Country:US
Practice Address - Phone:630-788-6019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-09
Last Update Date:2012-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-003427235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist