Provider Demographics
NPI:1619738259
Name:HUMPHREY, LINDY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LINDY
Middle Name:
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 BUFORD HWY STE 1001-110
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-7808
Mailing Address - Country:US
Mailing Address - Phone:678-243-0070
Mailing Address - Fax:678-250-0073
Practice Address - Street 1:500 BUFORD HWY STE 1001-110
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-7808
Practice Address - Country:US
Practice Address - Phone:678-243-0070
Practice Address - Fax:678-250-0070
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP012470235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist