Provider Demographics
NPI:1265770044
Name:GROVES, LINDSAY ELAINE (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:LINDSAY
Middle Name:ELAINE
Last Name:GROVES
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 1:4963 NW 2ND PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2282
Mailing Address - Country:US
Mailing Address - Phone:352-804-8265
Mailing Address - Fax:
Practice Address - Street 1:40 NW 1ST ST
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:FL
Practice Address - Zip Code:32696-2053
Practice Address - Country:US
Practice Address - Phone:352-529-0535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11586235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12156109OtherAMERICAN SPEECH LANGUAGE HEARING ASSOCIATION