Provider Demographics
NPI:1689247561
Name:DESCOTEAUX, LINDSAY SUSANNE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:SUSANNE
Last Name:DESCOTEAUX
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 MUIRFIELD TRL
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-8981
Mailing Address - Country:US
Mailing Address - Phone:859-608-3295
Mailing Address - Fax:
Practice Address - Street 1:814 MUIRFIELD TRL
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-8981
Practice Address - Country:US
Practice Address - Phone:859-608-3295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-20
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY271229235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY271229OtherSPEECH-LANGUAGE LICENSE