Provider Demographics
NPI:1538448881
Name:VASSALLO, LINDA KAY (MA)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:KAY
Last Name:VASSALLO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 BRICKELL AVE STE N1700
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-3105
Mailing Address - Country:US
Mailing Address - Phone:248-808-5463
Mailing Address - Fax:650-579-4471
Practice Address - Street 1:100 S ELLSWORTH AVE STE 711
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3927
Practice Address - Country:US
Practice Address - Phone:650-579-4470
Practice Address - Fax:650-579-4471
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000582231H00000X
CA3196231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist