Provider Demographics
NPI:1174364970
Name:ENDY, LILLIAN (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LILLIAN
Middle Name:
Last Name:ENDY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MRS
Other - First Name:LILLIAN
Other - Middle Name:
Other - Last Name:HOLGUIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:301 DOWNSVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-3814
Mailing Address - Country:US
Mailing Address - Phone:817-374-2018
Mailing Address - Fax:
Practice Address - Street 1:2365 S CLINTON AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2663
Practice Address - Country:US
Practice Address - Phone:585-758-5730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
14395014235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist