Provider Demographics
NPI:1558744979
Name:LYDER, JOAN ST MARIE
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:ST MARIE
Last Name:LYDER
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:PO BOX 6286
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98507-6286
Mailing Address - Country:US
Mailing Address - Phone:360-810-1547
Mailing Address - Fax:
Practice Address - Street 1:12040 98TH AVE NE
Practice Address - Street 2:STE 204
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-4290
Practice Address - Country:US
Practice Address - Phone:425-658-3016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst