Provider Demographics
NPI:1760821623
Name:MONTEIRO, LYNN MICHELE (CCC/SLP)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:MICHELE
Last Name:MONTEIRO
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:
Other - Last Name:MARTELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11066 SUSPENSE DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-1752
Mailing Address - Country:US
Mailing Address - Phone:954-648-8431
Mailing Address - Fax:
Practice Address - Street 1:1858 N ALAFAYA TRL
Practice Address - Street 2:SUITE 207
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-4728
Practice Address - Country:US
Practice Address - Phone:407-900-5313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA13182235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009106100Medicaid