MEDICARE: LINDSEY WALDOCK

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	SP.14084	OH

General Provider Information

NPI Number	:	1710592118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSEY WALDOCK

Provider Business Mailing Address
First Line	:	9356 OIL CENTER RD
Second Line	:
City	:	BLOOMDALE
State	:	OH
Zip	:	44817-9742
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2550 OH-100
Second Line	:
City	:	TIFFIN
State	:	OH
Zip	:	44883
Country	:	US
Telephone Number	:	419-447-7203
Fax Number	:

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

Provider Enumeration Date	:	09/11/2020
Last Update Date	:	10/26/2022

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Directions to “ LINDSEY WALDOCK ” Practice Location

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