Provider Demographics
NPI:1356696611
Name:LINDQUIST, ELISE M (MS-SLP)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:M
Last Name:LINDQUIST
Suffix:
Gender:F
Credentials:MS-SLP
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:
Other - Last Name:VENTURA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-4927
Mailing Address - Country:US
Mailing Address - Phone:814-946-5411
Mailing Address - Fax:814-940-8471
Practice Address - Street 1:201 CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4927
Practice Address - Country:US
Practice Address - Phone:814-946-5411
Practice Address - Fax:814-940-8471
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1213235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND56049Medicaid
PA1032525050001Medicaid