MEDICARE: MS. LINDSAY R GIBSON MA

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	22004333A	IN

General Provider Information

NPI Number	:	1790794642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LINDSAY R GIBSON MA

Provider Business Mailing Address
First Line	:	5429 COVE CT
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-5950
Country	:	US
Telephone Number	:	260-443-1970
Fax Number	:

Provider Business Practice Location Address
First Line	:	5429 COVE CT
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-5950
Country	:	US
Telephone Number	:	260-443-1970
Fax Number	:

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

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	03/27/2015

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