Provider Demographics
NPI:1538514542
Name:TILTON, LYNN MARIE
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:MARIE
Last Name:TILTON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LYNN
Other - Middle Name:MARIE
Other - Last Name:BOWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1208 PICKWICK DR
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE
Mailing Address - State:IL
Mailing Address - Zip Code:61068-1092
Mailing Address - Country:US
Mailing Address - Phone:815-761-2299
Mailing Address - Fax:
Practice Address - Street 1:325 IL ROUTE 2
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-9118
Practice Address - Country:US
Practice Address - Phone:815-622-7718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker