Healthcare Provider Details

I. General information

NPI: 1336477116
Provider Name (Legal Business Name): LINDSEY DIANE ABBAS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2009
Last Update Date: 11/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 CARDINAL DRIVE CIR
BROOKINGS SD
57006-3832
US

IV. Provider business mailing address

514 CARDINAL DRIVE CIR
BROOKINGS SD
57006-3832
US

V. Phone/Fax

Practice location:
  • Phone: 605-216-2924
  • Fax:
Mailing address:
  • Phone: 605-216-2924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12093152
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: