Provider Demographics
NPI:1619352812
Name:DOEPKER, LYNDA DIANNA
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:DIANNA
Last Name:DOEPKER
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 1:215 SHUMAN BLVD
Mailing Address - Street 2:STE 401
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8458
Mailing Address - Country:US
Mailing Address - Phone:630-303-5380
Mailing Address - Fax:978-313-6824
Practice Address - Street 1:425 N NEW BALLAS RD
Practice Address - Street 2:STE 195
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6845
Practice Address - Country:US
Practice Address - Phone:816-883-2681
Practice Address - Fax:314-839-5215
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015015742237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist