Provider Demographics
NPI:1689117392
Name:DOMENICK, LINDSAY MARIE (MA CCC-SLP TSSLD)
Entity Type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:MARIE
Last Name:DOMENICK
Suffix:
Gender:F
Credentials:MA CCC-SLP TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DOWNING ST APT 4J
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-4764
Mailing Address - Country:US
Mailing Address - Phone:914-462-1472
Mailing Address - Fax:
Practice Address - Street 1:351 W 18TH ST
Practice Address - Street 2:HUDSON HIGH SCHOOL OF LEARNING TECHNOLOGIES
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-4402
Practice Address - Country:US
Practice Address - Phone:914-462-1472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025383235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist