=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629234315
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA JOHANNA EYGNOR M.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2008
-----------------------------------------------------
Last Update Date | 08/01/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1519 NYE RD
-----------------------------------------------------
City | LYONS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14489-9133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-946-7262
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6814 DUTCH ST
-----------------------------------------------------
City | WOLCOTT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14590-9517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-573-4311
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 14850
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------