Provider Demographics
NPI:1710009931
Name:LILLY, LINDA P (MA CCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:P
Last Name:LILLY
Suffix:
Gender:F
Credentials:MA CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 VALEWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286
Mailing Address - Country:US
Mailing Address - Phone:410-887-6443
Mailing Address - Fax:410-574-7629
Practice Address - Street 1:9100 FRANKLIN SQUARE DR
Practice Address - Street 2:EASTERN FAMILY RESOURCE CENTER
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237
Practice Address - Country:US
Practice Address - Phone:410-887-6443
Practice Address - Fax:410-574-7629
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00074235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist