Provider Demographics
NPI:1427564251
Name:MILNER, LYNNETTE KAY (MS, CCC-SLP-L)
Entity Type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:KAY
Last Name:MILNER
Suffix:
Gender:F
Credentials:MS, CCC-SLP-L
Other - Prefix:MRS
Other - First Name:LYNNETTE
Other - Middle Name:KAY
Other - Last Name:MILNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS,CCC/SLP-L
Mailing Address - Street 1:1913 BUTLER BLVD
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025
Mailing Address - Country:US
Mailing Address - Phone:618-910-7466
Mailing Address - Fax:
Practice Address - Street 1:1913 BUTLER BLVD
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-3618
Practice Address - Country:US
Practice Address - Phone:618-910-7466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146002614235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty