Provider Demographics
NPI:1013274497
Name:SICKMAN, LINDA SUE (PHD, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:SUE
Last Name:SICKMAN
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4906 FALL BROOK LN
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835-9331
Mailing Address - Country:US
Mailing Address - Phone:260-458-4055
Mailing Address - Fax:
Practice Address - Street 1:1717 MAPLECREST RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-7656
Practice Address - Country:US
Practice Address - Phone:260-493-0012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002795A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist