Provider Demographics
NPI:1609998046
Name:DETWEILER-NEWCOMB, LYNDA GAYLE (SLP6849)
Entity Type:Individual
Prefix:MRS
First Name:LYNDA
Middle Name:GAYLE
Last Name:DETWEILER-NEWCOMB
Suffix:
Gender:F
Credentials:SLP6849
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:543 ENCINITAS BLVD
Mailing Address - Street 2:100
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3744
Mailing Address - Country:US
Mailing Address - Phone:760-634-6886
Mailing Address - Fax:760-634-0646
Practice Address - Street 1:543 ENCINITAS BLVD
Practice Address - Street 2:100
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3744
Practice Address - Country:US
Practice Address - Phone:760-634-6886
Practice Address - Fax:760-634-0646
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6849235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist