Provider Demographics
NPI:1255069597
Name:KISHTOK, LINDA HU (SLP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:HU
Last Name:KISHTOK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 SUNCREST CT
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9671
Mailing Address - Country:US
Mailing Address - Phone:407-342-9279
Mailing Address - Fax:
Practice Address - Street 1:20480 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33954-2264
Practice Address - Country:US
Practice Address - Phone:941-235-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-14
Last Update Date:2022-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA16182235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist