Provider Demographics
NPI:1649519810
Name:LEIST, LINDSEY GARDNER
Entity type:Individual
Prefix:MRS
First Name:LINDSEY
Middle Name:GARDNER
Last Name:LEIST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3474 FAIRWAY LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-2904
Mailing Address - Country:US
Mailing Address - Phone:813-404-7707
Mailing Address - Fax:
Practice Address - Street 1:3474 FAIRWAY LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-2904
Practice Address - Country:US
Practice Address - Phone:813-404-7707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ6138235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist