Provider Demographics
NPI:1598737934
Name:LYON, KRISTI-LEIGH (MACCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI-LEIGH
Middle Name:
Last Name:LYON
Suffix:
Gender:F
Credentials:MACCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21727 BELVEDERE LANE
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-7339
Mailing Address - Country:US
Mailing Address - Phone:239-253-1290
Mailing Address - Fax:239-221-0476
Practice Address - Street 1:21727 BELVEDERE LANE
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-7339
Practice Address - Country:US
Practice Address - Phone:239-253-1290
Practice Address - Fax:239-221-0476
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7636235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889669100Medicaid