Provider Demographics
NPI:1376880435
Name:MCCLINTOCK, LYNNE A (MA)
Entity Type:Individual
Prefix:MS
First Name:LYNNE
Middle Name:A
Last Name:MCCLINTOCK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 FAWN DR
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-2602
Mailing Address - Country:US
Mailing Address - Phone:908-246-0664
Mailing Address - Fax:908-782-2178
Practice Address - Street 1:18 FAWN DR
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-2602
Practice Address - Country:US
Practice Address - Phone:908-246-0664
Practice Address - Fax:908-782-2178
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00371300235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist