Provider Demographics
NPI:1699070243
Name:LINDT, LISA (MS ED)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LINDT
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 BURLINGTON AVE UNIT 308
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-4794
Mailing Address - Country:US
Mailing Address - Phone:620-921-5055
Mailing Address - Fax:
Practice Address - Street 1:935 BURLINGTON AVE UNIT 308
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-4794
Practice Address - Country:US
Practice Address - Phone:620-921-5055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No174400000XOther Service ProvidersSpecialist