Provider Demographics
NPI:1083161988
Name:KLAMERUS, LYNN ANN (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:ANN
Last Name:KLAMERUS
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1344 W ELMDALE AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-4978
Mailing Address - Country:US
Mailing Address - Phone:702-908-2373
Mailing Address - Fax:
Practice Address - Street 1:1344 W ELMDALE AVE APT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-4978
Practice Address - Country:US
Practice Address - Phone:702-908-2373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-08
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-17-26240103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst