Provider Demographics
NPI:1093599151
Name:MANSFIELD, LINDSAY MERLE (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:LINDSAY
Middle Name:MERLE
Last Name:MANSFIELD
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MRS
Other - First Name:LINDSAY
Other - Middle Name:MERLE
Other - Last Name:CASTILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:327 LOGAN DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-7146
Mailing Address - Country:US
Mailing Address - Phone:801-404-2537
Mailing Address - Fax:
Practice Address - Street 1:40 SIGNAL HILL PL
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-1699
Practice Address - Country:US
Practice Address - Phone:618-397-0325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14421272235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist