Provider Demographics
NPI:1609152321
Name:HUTCHESON, LINDSAY M (M ED CCC/SLP)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:M
Last Name:HUTCHESON
Suffix:
Gender:F
Credentials:M ED CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 PETERSON AVE S
Mailing Address - Street 2:STE B
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-5244
Mailing Address - Country:US
Mailing Address - Phone:912-331-0846
Mailing Address - Fax:678-792-4894
Practice Address - Street 1:515 PETERSON AVE S
Practice Address - Street 2:STE B
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-5244
Practice Address - Country:US
Practice Address - Phone:912-501-4047
Practice Address - Fax:912-501-5289
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007755235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003116223OMedicaid
GA003116223HMedicaid
GA033116223AMedicaid