Provider Demographics
NPI:1023318797
Name:CONSTANTINE, LINDSEY (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:CONSTANTINE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7512 DR PHILLIPS BLVD
Mailing Address - Street 2:SUITE 50-703
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5131
Mailing Address - Country:US
Mailing Address - Phone:407-906-7733
Mailing Address - Fax:
Practice Address - Street 1:9465 WICKHAM WAY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836-5521
Practice Address - Country:US
Practice Address - Phone:407-906-7733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-28
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11455235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004041300Medicaid