Provider Demographics
NPI:1003912320
Name:VAN CLEAVE, LYNN A (CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:A
Last Name:VAN CLEAVE
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 MORRILL RD
Mailing Address - Street 2:
Mailing Address - City:CANTERBURY
Mailing Address - State:NH
Mailing Address - Zip Code:03224
Mailing Address - Country:US
Mailing Address - Phone:603-783-0261
Mailing Address - Fax:
Practice Address - Street 1:525 CLINTON ST
Practice Address - Street 2:
Practice Address - City:BOW
Practice Address - State:NH
Practice Address - Zip Code:03304
Practice Address - Country:US
Practice Address - Phone:603-226-3212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0336235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH22721YMedicare UPIN