Healthcare Provider Details

I. General information

NPI: 1366830986
Provider Name (Legal Business Name): LINDSAY WELLBROCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12082 QUAIL AVE N
STILLWATER MN
55082-5777
US

IV. Provider business mailing address

4015 ARCHDALE ST
MELBOURNE FL
32940-7898
US

V. Phone/Fax

Practice location:
  • Phone: 651-439-2207
  • Fax:
Mailing address:
  • Phone: 321-427-4213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1043474
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA14275
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: