Provider Demographics
NPI:1205051653
Name:HORST, RANDI LYNN (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:RANDI
Middle Name:LYNN
Last Name:HORST
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2214 DARREN DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-4752
Mailing Address - Country:US
Mailing Address - Phone:618-972-0097
Mailing Address - Fax:
Practice Address - Street 1:2214 DARREN DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-4752
Practice Address - Country:US
Practice Address - Phone:618-972-0097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist