Provider Demographics
NPI:1922372481
Name:LINDSEY, MARIA RENEE (SLP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:RENEE
Last Name:LINDSEY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 LANCELOT CT
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-4138
Mailing Address - Country:US
Mailing Address - Phone:678-388-3984
Mailing Address - Fax:678-388-3984
Practice Address - Street 1:1202 LANCELOT CT
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-4138
Practice Address - Country:US
Practice Address - Phone:678-388-3984
Practice Address - Fax:678-388-3984
Is Sole Proprietor?:No
Enumeration Date:2012-03-01
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007070235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003121176EMedicaid