MEDICARE: MS. LINDY SYLVAN POTTINGER PH.D.

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	103G00000X	Clinical Neuropsychologist	31374	TX

General Provider Information

NPI Number	:	1568636892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LINDY SYLVAN POTTINGER PH.D.

Provider Business Mailing Address
First Line	:	5232 VILLAGE CREEK DR
Second Line	:	SUITE 200
City	:	PLANO
State	:	TX
Zip	:	75093-4437
Country	:	US
Telephone Number	:	972-490-5757
Fax Number	:	972-250-3364

Provider Business Practice Location Address
First Line	:	5232 VILLAGE CREEK DR
Second Line	:	SUITE 200
City	:	PLANO
State	:	TX
Zip	:	75093-4437
Country	:	US
Telephone Number	:	972-490-5757
Fax Number	:	972-250-3644

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

Provider Enumeration Date	:	04/17/2008
Last Update Date	:	04/17/2008

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