MEDICARE: LINDSAY BUECHTER BLACKSTOCK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLP010635	GA

General Provider Information

NPI Number	:	1053085837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSAY BUECHTER BLACKSTOCK

Provider Business Mailing Address
First Line	:	5153 LAKESPRINGS CT
Second Line	:
City	:	DUNWOODY
State	:	GA
Zip	:	30338-4405
Country	:	US
Telephone Number	:	770-331-1319
Fax Number	:

Provider Business Practice Location Address
First Line	:	5871 GLENRIDGE DR STE 110
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-5304
Country	:	US
Telephone Number	:	678-527-3224
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2021
Last Update Date	:	07/19/2022

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Directions to “ LINDSAY BUECHTER BLACKSTOCK ” Practice Location

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