Provider Demographics
NPI:1689974115
Name:KEIPPER, LYNDA D (CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:LYNDA
Middle Name:D
Last Name:KEIPPER
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 1:1773 HUTH RD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-1160
Mailing Address - Country:US
Mailing Address - Phone:716-773-8850
Mailing Address - Fax:
Practice Address - Street 1:1773 HUTH RD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NY
Practice Address - Zip Code:14072-1160
Practice Address - Country:US
Practice Address - Phone:716-773-8850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009461-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist