Provider Demographics
NPI:1437505476
Name:BUGNA, LINDSEY ENTZMINGER (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:ENTZMINGER
Last Name:BUGNA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 LITTLE RD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33548-4728
Mailing Address - Country:US
Mailing Address - Phone:813-817-9782
Mailing Address - Fax:
Practice Address - Street 1:518 W FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-3419
Practice Address - Country:US
Practice Address - Phone:813-265-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11899235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist