Provider Demographics
NPI:1720399470
Name:KNIGHT, LYNDE BOOTHROYD (MA-CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LYNDE
Middle Name:BOOTHROYD
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:MA-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:PO BOX 4103
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93921-4103
Mailing Address - Country:US
Mailing Address - Phone:408-656-2382
Mailing Address - Fax:
Practice Address - Street 1:25524 HATTON RD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93923-8221
Practice Address - Country:US
Practice Address - Phone:408-656-2382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11689235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist