Provider Demographics
NPI:1639686983
Name:MCCORMICK, LINDSAY RYAN (MS CCC SLP)
Entity type:Individual
Prefix:MS
First Name:LINDSAY
Middle Name:RYAN
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 S 3RD ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-4506
Mailing Address - Country:US
Mailing Address - Phone:434-480-1508
Mailing Address - Fax:
Practice Address - Street 1:315 S 3RD ST UNIT B
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-4506
Practice Address - Country:US
Practice Address - Phone:434-480-1508
Practice Address - Fax:434-480-1508
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10306235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty