Provider Demographics
NPI:1265743207
Name:CHAMPION, LINDSIE HOPE (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LINDSIE
Middle Name:HOPE
Last Name:CHAMPION
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 HAWKINS FARM LN
Mailing Address - Street 2:
Mailing Address - City:BALL GROUND
Mailing Address - State:GA
Mailing Address - Zip Code:30107-4389
Mailing Address - Country:US
Mailing Address - Phone:678-454-0647
Mailing Address - Fax:
Practice Address - Street 1:100 W WALNUT AVE STE 92
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8441
Practice Address - Country:US
Practice Address - Phone:706-272-2219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006906235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist