Healthcare Provider Details

I. General information

NPI: 1053936567
Provider Name (Legal Business Name): LYNNZI A. ESQUILIN M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 AUSTIN AVE
GREENVILLE RI
02828-1449
US

IV. Provider business mailing address

20 AUSTIN AVE
GREENVILLE RI
02828-1449
US

V. Phone/Fax

Practice location:
  • Phone: 401-949-3880
  • Fax:
Mailing address:
  • Phone: 401-949-3880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP01387
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: