Provider Demographics
NPI:1679707079
Name:NETTLETON, LINDY KAY (MS)
Entity Type:Individual
Prefix:MRS
First Name:LINDY
Middle Name:KAY
Last Name:NETTLETON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:LINDY
Other - Middle Name:KAY
Other - Last Name:HERZOG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,
Mailing Address - Street 1:2450 NE MARY ROSE PLACE, STE 120
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701
Mailing Address - Country:US
Mailing Address - Phone:541-312-7056
Mailing Address - Fax:541-312-7063
Practice Address - Street 1:1020 SW INDIAN AVE STE 102
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756
Practice Address - Country:US
Practice Address - Phone:541-749-2881
Practice Address - Fax:541-385-4935
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR30869231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500717298Medicaid
OR500717298Medicaid