Provider Demographics
NPI:1881825925
Name:SHORTER, LYNDA JANE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LYNDA
Middle Name:JANE
Last Name:SHORTER
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 1:1208 HIGH BROOK DR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6740
Mailing Address - Country:US
Mailing Address - Phone:808-352-7176
Mailing Address - Fax:
Practice Address - Street 1:1208 HIGH BROOK DR
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-6740
Practice Address - Country:US
Practice Address - Phone:808-352-7176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HISP 1066235Z00000X
NC8791235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist