Provider Demographics
NPI:1194750927
Name:REID, LYDIA DACHELL (SLPD)
Entity type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:DACHELL
Last Name:REID
Suffix:
Gender:F
Credentials:SLPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5077 NW 7TH ST APT 1604
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3467
Mailing Address - Country:US
Mailing Address - Phone:954-775-5013
Mailing Address - Fax:
Practice Address - Street 1:5077 NW 7TH ST APT 1604
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3467
Practice Address - Country:US
Practice Address - Phone:954-775-5013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 4876235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88427440Medicaid