Lydia Green, MS CCC SLP
Individual provider Active NPI Speech-Language Pathologist · Downs, IL
NPI 1104337948 · NPPES record last updated Oct 19, 2017
Key facts
- NPI
- 1104337948
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 146.008072 (IL)
- Practice address
- 409 E Washington St
Downs, IL 61736-9380 - Phone
- (309) 378-2031
- NPI assigned
- Oct 19, 2017
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 146.008072 | IL | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 146.008072 | IL | Yes |
Addresses
Primary practice location
409 E Washington St
Downs, IL 61736-9380
Mailing address
409 E Washington St
Downs, IL 61736-9380
Phone (309) 378-2031
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- Nestor Gutierrez
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- Dawn Ranee Ritter
- Tri Valley Community Unit School District #3
- Anita Marie Winger
All providers in Downs, IL · Speech-Language Pathologist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 19, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.