Provider Demographics
NPI:1720464902
Name:EVANS, LYNDSEY
Entity Type:Individual
Prefix:
First Name:LYNDSEY
Middle Name:
Last Name:EVANS
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 1:935 E WINDING CREEK DR STE 120
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-7242
Mailing Address - Country:US
Mailing Address - Phone:208-938-4748
Mailing Address - Fax:208-938-1710
Practice Address - Street 1:935 E WINDING CREEK DR STE 120
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-7242
Practice Address - Country:US
Practice Address - Phone:208-938-4748
Practice Address - Fax:208-938-1710
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-3093235Z00000X
IDTSLP-2777235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist