Provider Demographics
NPI:1104690908
Name:HAMILTON, LINDA (MS,CCC-SLP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10635 PINE NEEDLE DR
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34945-2200
Mailing Address - Country:US
Mailing Address - Phone:772-206-1418
Mailing Address - Fax:
Practice Address - Street 1:401 S 33RD ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-3536
Practice Address - Country:US
Practice Address - Phone:772-461-2232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5972235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist