Healthcare Provider Details

I. General information

NPI: 1992620264
Provider Name (Legal Business Name): LYNNE MARIE GOLDEN MA, CCC SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 EAST ST
HOLLY MI
48442
US

IV. Provider business mailing address

3255 DAWSON DR
WARREN MI
48092-3207
US

V. Phone/Fax

Practice location:
  • Phone: 248-328-3400
  • Fax:
Mailing address:
  • Phone: 586-246-8923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101002709
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: