Provider Demographics
NPI:1881035236
Name:THEOBALD, LINDSAY (LLMSW)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:THEOBALD
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:217 E SANILAC RD
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:MI
Mailing Address - Zip Code:48471-1383
Mailing Address - Country:US
Mailing Address - Phone:810-648-0330
Mailing Address - Fax:
Practice Address - Street 1:217 E SANILAC RD
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-1383
Practice Address - Country:US
Practice Address - Phone:810-648-0330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker