Provider Demographics
NPI:1083229959
Name:LYNCH, NEIL P (MA)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:P
Last Name:LYNCH
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 W MEQUON ROAD
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3230
Mailing Address - Country:US
Mailing Address - Phone:414-292-4242
Mailing Address - Fax:262-240-9745
Practice Address - Street 1:1655 W MEQUON RD
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3230
Practice Address - Country:US
Practice Address - Phone:414-292-4242
Practice Address - Fax:262-240-9745
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1083229959Medicaid