Provider Demographics
NPI:1861524803
Name:LYNDE, SUE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:LYNDE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15029 N THOMPSON PEAK PKWY
Mailing Address - Street 2:STE. B111-628
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2217
Mailing Address - Country:US
Mailing Address - Phone:480-484-4000
Mailing Address - Fax:480-656-2416
Practice Address - Street 1:9181 E REDFIELD RD
Practice Address - Street 2:ZUNI ELEMENTARY SCHOOL
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-7557
Practice Address - Country:US
Practice Address - Phone:480-484-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP4779235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist