Provider Demographics
NPI:1538607007
Name:CAZIER, LYNLEY PETERSON (CCC-SLP)
Entity type:Individual
Prefix:
First Name:LYNLEY
Middle Name:PETERSON
Last Name:CAZIER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12179 N KELLY RAE DR
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-9482
Mailing Address - Country:US
Mailing Address - Phone:208-518-6551
Mailing Address - Fax:208-719-7910
Practice Address - Street 1:3815 N SCHREIBER WAY UNIT 103
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8434
Practice Address - Country:US
Practice Address - Phone:208-518-6551
Practice Address - Fax:208-719-7910
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-05
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9481211-4102235Z00000X
IDSLP-3158235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist