Provider Demographics
NPI:1588600860
Name:PICON, LINDA M (MCD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:PICON
Suffix:
Gender:F
Credentials:MCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 TULLAMORE DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-3949
Mailing Address - Country:US
Mailing Address - Phone:813-972-7529
Mailing Address - Fax:813-978-5812
Practice Address - Street 1:13000 BRUCE B DOWNS BLVD
Practice Address - Street 2:AUDIOLOGY AND SPEECH PATHOLOGY (126)
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-4745
Practice Address - Country:US
Practice Address - Phone:813-972-7529
Practice Address - Fax:813-978-5812
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 5029235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist