Provider Demographics
NPI:1104593649
Name:HANSON, LYNDA ELIZABETH (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:ELIZABETH
Last Name:HANSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:LYNDI
Other - Middle Name:ELIZABETH
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:3488 JEFFCO BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-6015
Mailing Address - Country:US
Mailing Address - Phone:636-464-5439
Mailing Address - Fax:636-464-5438
Practice Address - Street 1:3488 JEFFCO BLVD STE 102
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-6015
Practice Address - Country:US
Practice Address - Phone:636-464-5439
Practice Address - Fax:636-464-5438
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020029604235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist