Provider Demographics
NPI:1356570717
Name:WIMBERLY, LINDSAY (MCD CF SLP)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:WIMBERLY
Suffix:
Gender:F
Credentials:MCD CF SLP
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MCD SLP
Mailing Address - Street 1:2424 DOUBLE CHURCHES RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-2741
Mailing Address - Country:US
Mailing Address - Phone:706-324-6112
Mailing Address - Fax:706-596-8259
Practice Address - Street 1:2424 DOUBLE CHURCHES RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-2741
Practice Address - Country:US
Practice Address - Phone:706-324-6112
Practice Address - Fax:706-596-8259
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003116291AMedicaid