Provider Demographics
NPI:1659491017
Name:MENAKER, LYNNE ALLISON (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:ALLISON
Last Name:MENAKER
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:705 CABLE BEACH LN
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33410-3411
Mailing Address - Country:US
Mailing Address - Phone:561-309-7383
Mailing Address - Fax:561-799-9918
Practice Address - Street 1:705 CABLE BEACH LN
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-3411
Practice Address - Country:US
Practice Address - Phone:561-309-7383
Practice Address - Fax:561-799-9918
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
252Y00000X
FLSA4206235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8840121Medicaid