Provider Demographics
NPI:1184943516
Name:ETTELSON, LINDSAY MARIE (MS,CCC-SLP/L)
Entity type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:MARIE
Last Name:ETTELSON
Suffix:
Gender:F
Credentials:MS,CCC-SLP/L
Other - Prefix:MISS
Other - First Name:LINDSAY
Other - Middle Name:MARIE
Other - Last Name:ROHRBACHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10803 LAKE AVE APT 203
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-1250
Mailing Address - Country:US
Mailing Address - Phone:419-366-0615
Mailing Address - Fax:
Practice Address - Street 1:9200 BIDDULPH RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:OH
Practice Address - Zip Code:44144-2614
Practice Address - Country:US
Practice Address - Phone:216-485-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
IL146.009842235Z00000X
OHSP.12900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist