Provider Demographics
NPI:1407917321
Name:CREED, LYNNETTE M
Entity Type:Individual
Prefix:MRS
First Name:LYNNETTE
Middle Name:M
Last Name:CREED
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 1:920 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-2563
Mailing Address - Country:US
Mailing Address - Phone:573-581-3773
Mailing Address - Fax:573-581-4410
Practice Address - Street 1:704 W BOULEVARD ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-2192
Practice Address - Country:US
Practice Address - Phone:573-581-3773
Practice Address - Fax:573-581-4410
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO108892235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist