=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578339404
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REGINA C LINDSAY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2023
-----------------------------------------------------
Last Update Date | 05/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1328 IL-16, PO BO 42
-----------------------------------------------------
City | PIASA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62079-6207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-409-4074
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 42
-----------------------------------------------------
City | PIASA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62079-0042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-409-4074
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------