Provider Demographics
NPI:1558790147
Name:LYNN, NATALIE E (MSW)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:E
Last Name:LYNN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3662 W LINDA LN
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-5902
Mailing Address - Country:US
Mailing Address - Phone:480-231-5332
Mailing Address - Fax:
Practice Address - Street 1:3662 W LINDA LN
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-5902
Practice Address - Country:US
Practice Address - Phone:480-231-5332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-109771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ162409Medicare PIN
AZ861745Medicaid