Provider Demographics
NPI:1487932950
Name:BEANBLOSSOM, LYNDSIE ALBRIGHT
Entity type:Individual
Prefix:
First Name:LYNDSIE
Middle Name:ALBRIGHT
Last Name:BEANBLOSSOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 WATCH HILL LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-2200
Mailing Address - Country:US
Mailing Address - Phone:502-645-4331
Mailing Address - Fax:
Practice Address - Street 1:420 WATCH HILL LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-2200
Practice Address - Country:US
Practice Address - Phone:502-645-4331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency