Provider Demographics
NPI:1639521230
Name:CLARK, LINDSEY (MS, CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 ANTIETAM ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-1124
Mailing Address - Country:US
Mailing Address - Phone:724-679-4930
Mailing Address - Fax:
Practice Address - Street 1:1800 ANTIETAM ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-1124
Practice Address - Country:US
Practice Address - Phone:724-679-4930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL010551235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7688Medicaid