Provider Demographics
NPI:1326191925
Name:LYNCH, SHANNON M (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:M
Last Name:LYNCH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PSYCHOLOGY DEPARTMENT
Mailing Address - Street 2:921 SO 8TH AVE, STOP 8112
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83209-0001
Mailing Address - Country:US
Mailing Address - Phone:208-282-2110
Mailing Address - Fax:208-282-5411
Practice Address - Street 1:ISU PSYCHOLOGY CLINIC
Practice Address - Street 2:IDAHO STATE UNIVERSITY, STOP 8112
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83209-0001
Practice Address - Country:US
Practice Address - Phone:208-282-2129
Practice Address - Fax:208-282-5411
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDPSY-202220103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical