Provider Demographics
NPI:1962140509
Name:WILSON, LINDSAY DENISE (BC-HIS)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:DENISE
Last Name:WILSON
Suffix:
Gender:
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:997 E COUNTY LINE RD STE F
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1076
Mailing Address - Country:US
Mailing Address - Phone:317-889-0585
Mailing Address - Fax:
Practice Address - Street 1:799 E 3RD ST
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5793
Practice Address - Country:US
Practice Address - Phone:970-375-2369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001620A237700000X
COHAD.0000459237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist