Provider Demographics
NPI:1053591552
Name:LILLY, LINDSAY D (MS)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:D
Last Name:LILLY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:D
Other - Last Name:GARRETSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-2602
Mailing Address - Country:US
Mailing Address - Phone:304-622-4327
Mailing Address - Fax:
Practice Address - Street 1:125 N 6TH ST
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-2665
Practice Address - Country:US
Practice Address - Phone:304-622-4327
Practice Address - Fax:304-623-4823
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVA-0215237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter