Basic Information
| Provider Information | |||||||||
| NPI: | 1326294182 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRINCE | ||||||||
| FirstName: | LINDSAY | ||||||||
| MiddleName: | ELLIS | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4628 KNIGHT PL | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223114924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042373828 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8008 WESTPARK DR | ||||||||
| Address2: | |||||||||
| City: | MC LEAN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032876400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2008 | ||||||||
| LastUpdateDate: | 07/02/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | COND2007186 | OH | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.