Provider Demographics
NPI:1447396254
Name:KEIDAN, LYNN CAROL (LMSW)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:CAROL
Last Name:KEIDAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31092 N PARK DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-1447
Mailing Address - Country:US
Mailing Address - Phone:248-330-1768
Mailing Address - Fax:
Practice Address - Street 1:33300 FIVE MILE RD STE 208
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-3077
Practice Address - Country:US
Practice Address - Phone:734-522-0280
Practice Address - Fax:734-522-3654
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010132971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM15013Medicare UPIN
MI1883825Medicaid