Provider Demographics
NPI:1194724468
Name:FARLEY, LINDA M (MS CCCA)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:M
Last Name:FARLEY
Suffix:
Gender:F
Credentials:MS CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18202
Mailing Address - Country:US
Mailing Address - Phone:570-454-8404
Mailing Address - Fax:570-454-8404
Practice Address - Street 1:1523 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18202
Practice Address - Country:US
Practice Address - Phone:570-454-8404
Practice Address - Fax:570-454-8404
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2007-08-09
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
PAAT000056L231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014129200005Medicaid
PA207475OtherBLUE SHIELD
PA0014129200005Medicaid
PA207475OtherBLUE SHIELD