Healthcare Provider Details

I. General information

NPI: 1093951014
Provider Name (Legal Business Name): LINDSAY MARIE WACHOWIAK SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDSAY MARIE PICKARD

II. Dates (important events)

Enumeration Date: 12/22/2008
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ELM AND CARLTON STREETS
BUFFALO NY
14263-0001
US

IV. Provider business mailing address

ELM AND CARLTON STREETS
BUFFALO NY
14263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 716-845-2300
  • Fax: 716-845-4341
Mailing address:
  • Phone: 716-845-2300
  • Fax: 716-845-4341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081H0002X
TaxonomyHospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
License Number016412
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number016412
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: