Provider Demographics
NPI:1063733780
Name:MOWEN, LINDSAY RYANNA (MS, CCC-SLP/L)
Entity type:Individual
Prefix:MS
First Name:LINDSAY
Middle Name:RYANNA
Last Name:MOWEN
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5317 BILTMORE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-5688
Mailing Address - Country:US
Mailing Address - Phone:217-653-2847
Mailing Address - Fax:
Practice Address - Street 1:5317 BILTMORE DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-5688
Practice Address - Country:US
Practice Address - Phone:217-653-2847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.009812235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist