Healthcare Provider Details

I. General information

NPI: 1831519735
Provider Name (Legal Business Name): LINDSEY GREEN M.S. CCC, SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2014
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 APACHE DR
JONESBORO AR
72401-7432
US

IV. Provider business mailing address

123 COUNTY ROAD 457
JONESBORO AR
72404-8225
US

V. Phone/Fax

Practice location:
  • Phone: 870-336-0238
  • Fax:
Mailing address:
  • Phone: 870-761-4530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14109861
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP#8758
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: