Provider Demographics
NPI:1770397614
Name:WELLER, LYNNE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:
Last Name:WELLER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NE 6TH ST UNIT 306
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-4162
Mailing Address - Country:US
Mailing Address - Phone:386-337-0300
Mailing Address - Fax:
Practice Address - Street 1:100 NE 6TH ST UNIT 306
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-4162
Practice Address - Country:US
Practice Address - Phone:386-337-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11007235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist