Healthcare Provider Details

I. General information

NPI: 1871414193
Provider Name (Legal Business Name): LYDIA MASSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 STATE HIGHWAY DD
MARSHFIELD MO
65706-1513
US

IV. Provider business mailing address

12480 REDBUD DR
LEBANON MO
65536-7547
US

V. Phone/Fax

Practice location:
  • Phone: 417-859-2120
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number2026013092
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: