MEDICARE: LYNLEY PETERSON CAZIER CCC-SLP

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	9481211-4102	UT
2	235Z00000X	Speech-Language Pathologist	SLP-3158	ID

General Provider Information

NPI Number	:	1538607007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNLEY PETERSON CAZIER CCC-SLP

Provider Business Mailing Address
First Line	:	12179 N KELLY RAE DR
Second Line	:
City	:	HAYDEN
State	:	ID
Zip	:	83835-9482
Country	:	US
Telephone Number	:	208-518-6551
Fax Number	:	208-719-7910

Provider Business Practice Location Address
First Line	:	3815 N SCHREIBER WAY UNIT 103
Second Line	:
City	:	COEUR D ALENE
State	:	ID
Zip	:	83815-8434
Country	:	US
Telephone Number	:	208-518-6551
Fax Number	:	208-719-7910

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

Provider Enumeration Date	:	02/05/2017
Last Update Date	:	12/27/2024

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Directions to “ LYNLEY PETERSON CAZIER CCC-SLP” Practice Location

Language	Start Address	Practice Location

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