Provider Demographics
NPI:1386000396
Name:WAKEMAN, LYNN MARIE
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:MARIE
Last Name:WAKEMAN
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 1:514 E BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MONTESANO
Mailing Address - State:WA
Mailing Address - Zip Code:98563-3815
Mailing Address - Country:US
Mailing Address - Phone:360-591-9302
Mailing Address - Fax:360-249-0030
Practice Address - Street 1:514 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MONTESANO
Practice Address - State:WA
Practice Address - Zip Code:98563-3815
Practice Address - Country:US
Practice Address - Phone:360-591-9302
Practice Address - Fax:360-249-0030
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor