Provider Demographics
NPI:1346379575
Name:LYNCH, LA DONNA S
Entity Type:Individual
Prefix:MRS
First Name:LA DONNA
Middle Name:S
Last Name:LYNCH
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 1:20794 US HIGHWAY 61
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-7260
Mailing Address - Country:US
Mailing Address - Phone:573-471-3511
Mailing Address - Fax:573-471-3515
Practice Address - Street 1:20794 US HIGHWAY 61
Practice Address - Street 2:SCOTT COUNTY CENTRAL
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-7260
Practice Address - Country:US
Practice Address - Phone:573-471-3511
Practice Address - Fax:573-471-3515
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO114579235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO464725118Medicaid