Provider Demographics
NPI:1790957074
Name:DISTEFANO, LYNDA A (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:LYNDA
Middle Name:A
Last Name:DISTEFANO
Suffix:
Gender:
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 1:166 BAY SPRING AVE
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-1393
Mailing Address - Country:US
Mailing Address - Phone:401-359-4898
Mailing Address - Fax:401-336-2442
Practice Address - Street 1:640 GEORGE WASHINGTON HIGHWAY
Practice Address - Street 2:BUILDING B
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865
Practice Address - Country:US
Practice Address - Phone:401-359-4898
Practice Address - Fax:401-336-2442
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP00880235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3041OtherSTATE LICENSE
010880005OtherASHA MEMBERSHIP
RISP00880OtherSTATE LICENSE