Provider Demographics
NPI:1659992618
Name:NELSON, LINDSEY M (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:M
Last Name:NELSON
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 VALLEY RESERVE DR NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-4847
Mailing Address - Country:US
Mailing Address - Phone:706-975-6666
Mailing Address - Fax:
Practice Address - Street 1:1320 VALLEY RESERVE DR NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-4847
Practice Address - Country:US
Practice Address - Phone:706-975-6666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008115235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty