Provider Demographics
NPI:1053428029
Name:BENNETT, LINDSAY (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:
Other - Last Name:BOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CF-SLP
Mailing Address - Street 1:34 BLACKSTONE ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-4850
Mailing Address - Country:US
Mailing Address - Phone:207-215-6839
Mailing Address - Fax:
Practice Address - Street 1:34 BLACKSTONE ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4850
Practice Address - Country:US
Practice Address - Phone:207-215-6839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEST1663235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME018316OtherANTHEM BLUE CROSS AND BLU
ME432296399Medicaid