Provider Demographics
NPI:1114656626
Name:CREASAP, LYNN
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:CREASAP
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:PO BOX 105
Mailing Address - Street 2:
Mailing Address - City:IBERIA
Mailing Address - State:OH
Mailing Address - Zip Code:43325-0105
Mailing Address - Country:US
Mailing Address - Phone:419-685-5413
Mailing Address - Fax:
Practice Address - Street 1:6 PUBLIC SQ
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833-1926
Practice Address - Country:US
Practice Address - Phone:567-560-3583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.003273175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist