Provider Demographics
NPI:1609424670
Name:WALL, LINDSAY (AUD)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:WALL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:
Other - Last Name:BITTERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:25500 MEADOWBROOK RD STE 220
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1882
Mailing Address - Country:US
Mailing Address - Phone:248-488-7719
Mailing Address - Fax:248-522-0138
Practice Address - Street 1:25500 MEADOWBROOK RD STE 220
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1882
Practice Address - Country:US
Practice Address - Phone:248-488-7719
Practice Address - Fax:248-522-0138
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000854231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist