Provider Demographics
NPI:1265891469
Name:CHRISTIE, LYNDA JEAN (MA, CCC/SLP)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:JEAN
Last Name:CHRISTIE
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S CRYSTAL LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-6809
Mailing Address - Country:US
Mailing Address - Phone:407-463-3786
Mailing Address - Fax:
Practice Address - Street 1:601 S CRYSTAL LAKE DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-6809
Practice Address - Country:US
Practice Address - Phone:407-463-3786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA4075235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist