Provider Demographics
NPI:1831519735
Name:GREEN, LINDSEY (MS CCC, SLP)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
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 1:123 COUNTY ROAD 457
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-8225
Mailing Address - Country:US
Mailing Address - Phone:870-761-4530
Mailing Address - Fax:
Practice Address - Street 1:3005 APACHE DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-7432
Practice Address - Country:US
Practice Address - Phone:870-336-0238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-18
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR14109861235Z00000X
ARSP#8758235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist