Provider Demographics
NPI:1073798583
Name:LYNN, KIMBERLY ARRENA (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ARRENA
Last Name:LYNN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8056 S VICTORIA DR
Mailing Address - Street 2:
Mailing Address - City:FORT BRANCH
Mailing Address - State:IN
Mailing Address - Zip Code:47648-8101
Mailing Address - Country:US
Mailing Address - Phone:812-664-2929
Mailing Address - Fax:866-756-0806
Practice Address - Street 1:8056 S VICTORIA DR
Practice Address - Street 2:
Practice Address - City:FORT BRANCH
Practice Address - State:IN
Practice Address - Zip Code:47648-8101
Practice Address - Country:US
Practice Address - Phone:812-664-2929
Practice Address - Fax:866-756-0806
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003581A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist