Provider Demographics
NPI:1639792740
Name:DOUGLAS, LINDSAY ANNE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:ANNE
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 S FAIRWAY AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-0211
Mailing Address - Country:US
Mailing Address - Phone:417-343-9731
Mailing Address - Fax:
Practice Address - Street 1:3050 S NATIONAL AVE STE 106
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4242
Practice Address - Country:US
Practice Address - Phone:417-343-9731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-22
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004010703235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist