Provider Demographics
NPI:1184914434
Name:HEDRICK, LYNN U (MA,CCC,SLP,CDRS)
Entity type:Individual
Prefix:MS
First Name:LYNN
Middle Name:U
Last Name:HEDRICK
Suffix:
Gender:F
Credentials:MA,CCC,SLP,CDRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 N 20TH ST
Mailing Address - Street 2:STE. G
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-6022
Mailing Address - Country:US
Mailing Address - Phone:602-881-9500
Mailing Address - Fax:602-957-2943
Practice Address - Street 1:4120 N 20TH ST
Practice Address - Street 2:STE. G
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-6022
Practice Address - Country:US
Practice Address - Phone:602-881-9500
Practice Address - Fax:602-957-2943
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1145171W00000X
AZSLP5795235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZSLP5795OtherAZ DEPT OF HEALTH SERVICES
MD01113520OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION