Provider Demographics
NPI:1467631911
Name:BALLARD, LYNDI BERNHISEL (MS)
Entity type:Individual
Prefix:MRS
First Name:LYNDI
Middle Name:BERNHISEL
Last Name:BALLARD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 FLAGSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-1914
Mailing Address - Country:US
Mailing Address - Phone:480-299-1646
Mailing Address - Fax:
Practice Address - Street 1:843 FLAGSTONE WAY
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-1914
Practice Address - Country:US
Practice Address - Phone:480-299-1646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP5571235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist