Healthcare Provider Details

I. General information

NPI: 1386090041
Provider Name (Legal Business Name): LINDSEY REIMER M.S.,CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDSEY BOHLEN M.S, CCC-SLP

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 GOLF AVE
NEW LENOX IL
60451
US

IV. Provider business mailing address

3515 GOLF AVE
NEW LENOX IL
60451-9628
US

V. Phone/Fax

Practice location:
  • Phone: 708-712-8938
  • Fax:
Mailing address:
  • Phone: 708-712-8938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.013683
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number242.003943
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: