Provider Demographics
NPI:1811545817
Name:WHITE, LYNDA MCCALL (CCC-SP)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:MCCALL
Last Name:WHITE
Suffix:
Gender:F
Credentials:CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 CHERRY RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-7991
Mailing Address - Country:US
Mailing Address - Phone:502-744-5361
Mailing Address - Fax:
Practice Address - Street 1:13010 EASTGATE PARK WAY STE 101
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-3984
Practice Address - Country:US
Practice Address - Phone:502-244-1210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY244503235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY244503OtherKY SLP LICENCE