Basic Information
| Provider Information | |||||||||
| NPI: | 1578913448 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARGIS | ||||||||
| FirstName: | LINDSEY | ||||||||
| MiddleName: | RYAN-PENDER | ||||||||
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| Credential: | MS, CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 528 | ||||||||
| Address2: | ATTN: BH FIT PROGRAM | ||||||||
| City: | BETHEL | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075433690 | ||||||||
| FaxNumber: | 9075431276 | ||||||||
| Practice Location | |||||||||
| Address1: | 837 CHIEF EDDIE HOFFMAN HWY | ||||||||
| Address2: | |||||||||
| City: | BETHEL | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075433690 | ||||||||
| FaxNumber: | 9075431276 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2016 | ||||||||
| LastUpdateDate: | 06/29/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 113092 | AK | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 130688 | AK | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 1002573 | 05 | AK | MEDICAID |