Michelle Clarissa Lydon, SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

119046 Issued in TX

Practice address

2150 Trawood Dr Ste A100
El Paso, TX 79935-3383

Phone

(915) 259-5805

Fax

(915) 792-0576

NPI assigned

Feb 24, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1645660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647302400000",
    "number": "1124774450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2150 TRAWOOD DR STE A100",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799353383",
            "telephone_number": "915-259-5805",
            "fax_number": "915-792-0576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2150 TRAWOOD DR STE A100",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799353383",
            "telephone_number": "915-259-5805",
            "fax_number": "915-792-0576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYDON",
        "first_name": "MICHELLE",
        "middle_name": "CLARISSA",
        "credential": "SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-24",
        "last_updated": "2022-03-15",
        "certification_date": "2022-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TX",
            "license": "119046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "clinicsource.com",
            "affiliation": "N",
            "address_1": "2150 Trawood Dr Ste A100",
            "city": "El Paso",
            "state": "TX",
            "country_code": "US",
            "postal_code": "799353383",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Speech-Language Pathologist in El Paso, TX
• Providers in El Paso, TX by specialty
• Speech-Language Pathologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.