Provider Demographics
NPI:1720396013
Name:MIXON, LINDY MICHELLE (MSCCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LINDY
Middle Name:MICHELLE
Last Name:MIXON
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-5340
Mailing Address - Country:US
Mailing Address - Phone:405-474-1757
Mailing Address - Fax:
Practice Address - Street 1:420 E 5TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5340
Practice Address - Country:US
Practice Address - Phone:405-474-1757
Practice Address - Fax:405-844-1757
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2013-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2944235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist