Provider Demographics
NPI:1700035979
Name:NELSON, LINDA B (MACCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:B
Last Name:NELSON
Suffix:
Gender:F
Credentials:MACCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4785 KITTIWAKE CT
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-8864
Mailing Address - Country:US
Mailing Address - Phone:239-593-4551
Mailing Address - Fax:
Practice Address - Street 1:681 GOODLETTE RD N
Practice Address - Street 2:SUITE 150
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5458
Practice Address - Country:US
Practice Address - Phone:239-439-9512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9650235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist