Provider Demographics
NPI:1013548502
Name:FORTMAN, LYNDA A
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:A
Last Name:FORTMAN
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 1:835 N LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:OH
Mailing Address - Zip Code:45875-1216
Mailing Address - Country:US
Mailing Address - Phone:419-523-4300
Mailing Address - Fax:419-523-6188
Practice Address - Street 1:835 N LOCUST ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:OH
Practice Address - Zip Code:45875-1216
Practice Address - Country:US
Practice Address - Phone:419-523-4300
Practice Address - Fax:419-523-6188
Is Sole Proprietor?:No
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator