Provider Demographics
NPI:1386912137
Name:HARRIS LINDSTROM, SANDRA (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:HARRIS LINDSTROM
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 1:959 BEACH RD
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:NY
Mailing Address - Zip Code:14006-9702
Mailing Address - Country:US
Mailing Address - Phone:716-926-2221
Mailing Address - Fax:716-549-6228
Practice Address - Street 1:6745 ERIE RD
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:NY
Practice Address - Zip Code:14047-9670
Practice Address - Country:US
Practice Address - Phone:716-926-2460
Practice Address - Fax:716-947-9269
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005130235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist