Provider Demographics
NPI:1386044741
Name:EDMUNDS, LYNN (LAT)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:EDMUNDS
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 FOND DU LAC ST
Mailing Address - Street 2:
Mailing Address - City:WAUPUN
Mailing Address - State:WI
Mailing Address - Zip Code:53963-1511
Mailing Address - Country:US
Mailing Address - Phone:414-839-4476
Mailing Address - Fax:
Practice Address - Street 1:368 FOND DU LAC ST
Practice Address - Street 2:
Practice Address - City:WAUPUN
Practice Address - State:WI
Practice Address - Zip Code:53963-1511
Practice Address - Country:US
Practice Address - Phone:414-839-4476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4940392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer