Provider Demographics
NPI:1508050733
Name:BOLT, LINDA IRENE (MSCCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:IRENE
Last Name:BOLT
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:NEW KENSINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15068-7247
Mailing Address - Country:US
Mailing Address - Phone:724-335-8255
Mailing Address - Fax:
Practice Address - Street 1:100 LITTLE DR
Practice Address - Street 2:
Practice Address - City:LOWER BURRELL
Practice Address - State:PA
Practice Address - Zip Code:15068-3345
Practice Address - Country:US
Practice Address - Phone:724-339-1071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL004436L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist