MEDICARE: MS. LINDSAY MARIE JURGENS M.A. CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	026077	NY

General Provider Information

NPI Number	:	1598131591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LINDSAY MARIE JURGENS M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	204 37TH AVE N # 186
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33704-1416
Country	:	US
Telephone Number	:	516-382-1771
Fax Number	:

Provider Business Practice Location Address
First Line	:	5380 54TH AVE N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-2122
Country	:	US
Telephone Number	:	516-382-1771
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2015
Last Update Date	:	07/06/2024

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