Provider Demographics
NPI:1780954537
Name:LINDSAY, LISA J (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:LINDSAY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:J
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:43640 TEXAS AVE
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-7516
Mailing Address - Country:US
Mailing Address - Phone:442-241-8954
Mailing Address - Fax:
Practice Address - Street 1:43640 TEXAS AVE
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-7516
Practice Address - Country:US
Practice Address - Phone:442-241-8954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146010836235Z00000X
CA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist