Provider Demographics
NPI:1588831242
Name:KOLDON, LINDSY BROOKE
Entity Type:Individual
Prefix:
First Name:LINDSY
Middle Name:BROOKE
Last Name:KOLDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25654 N SOMERSET CT
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-7538
Mailing Address - Country:US
Mailing Address - Phone:847-438-4430
Mailing Address - Fax:
Practice Address - Street 1:25654 N SOMERSET CT
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-7538
Practice Address - Country:US
Practice Address - Phone:847-438-4430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist