Provider Demographics
NPI:1598264335
Name:MERRILL, LYNN C (MED, EDS)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:C
Last Name:MERRILL
Suffix:
Gender:F
Credentials:MED, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 STERLING LN
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-3230
Mailing Address - Country:US
Mailing Address - Phone:847-644-8278
Mailing Address - Fax:847-543-4132
Practice Address - Street 1:103 E BELVIDERE RD
Practice Address - Street 2:
Practice Address - City:HAINESVILLE
Practice Address - State:IL
Practice Address - Zip Code:60030-1004
Practice Address - Country:US
Practice Address - Phone:847-543-6225
Practice Address - Fax:847-543-4132
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2009410103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist