Provider Demographics
NPI:1023427960
Name:CRADDOCK, LINDSAY (MSCCC-SLP/L)
Entity type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:
Last Name:CRADDOCK
Suffix:
Gender:F
Credentials:MSCCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 PALO ALTO DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-6310
Mailing Address - Country:US
Mailing Address - Phone:217-553-6854
Mailing Address - Fax:
Practice Address - Street 1:900 N RUTLEDGE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-3721
Practice Address - Country:US
Practice Address - Phone:217-535-6509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.007340235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist