Provider Demographics
NPI:1477923308
Name:LYLE, MARTINE (MS)
Entity Type:Individual
Prefix:
First Name:MARTINE
Middle Name:
Last Name:LYLE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31064 DANIELS DR
Mailing Address - Street 2:
Mailing Address - City:GENOA
Mailing Address - State:IL
Mailing Address - Zip Code:60135-8172
Mailing Address - Country:US
Mailing Address - Phone:847-224-4227
Mailing Address - Fax:
Practice Address - Street 1:31064 DANIELS DR
Practice Address - Street 2:
Practice Address - City:GENOA
Practice Address - State:IL
Practice Address - Zip Code:60135-8172
Practice Address - Country:US
Practice Address - Phone:847-224-4227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker