Provider Demographics
NPI:1386921187
Name:LINK, LINDA R (SLP)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:R
Last Name:LINK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-6619
Mailing Address - Country:US
Mailing Address - Phone:516-938-6578
Mailing Address - Fax:516-644-5384
Practice Address - Street 1:60 CENTRAL BLVD
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-4623
Practice Address - Country:US
Practice Address - Phone:516-644-4324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001588235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist