Provider Demographics
NPI:1053548909
Name:LANDECK, LINDSEY RENAE (MT-BC)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:RENAE
Last Name:LANDECK
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 FULFORD ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-4525
Mailing Address - Country:US
Mailing Address - Phone:269-808-5456
Mailing Address - Fax:
Practice Address - Street 1:2509 FULFORD ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-4525
Practice Address - Country:US
Practice Address - Phone:269-808-5456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist