Provider Demographics
NPI:1972367498
Name:ENGLE, LYDIA ELAINE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:ELAINE
Last Name:ENGLE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 CLEARY DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-4498
Mailing Address - Country:US
Mailing Address - Phone:937-974-4498
Mailing Address - Fax:
Practice Address - Street 1:2900 N BECHTLE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-1599
Practice Address - Country:US
Practice Address - Phone:937-342-1460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.06075235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist