Provider Demographics
NPI:1639159866
Name:JAEGER, LYNN CALVIN (MS)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:CALVIN
Last Name:JAEGER
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 1:425 STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2232
Mailing Address - Country:US
Mailing Address - Phone:215-884-3544
Mailing Address - Fax:215-884-3545
Practice Address - Street 1:425 STEWART AVE
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2232
Practice Address - Country:US
Practice Address - Phone:215-884-3544
Practice Address - Fax:215-884-3545
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TA0400X, 103TB0200X, 103TC2200X
PAPS-006266-L103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPS-006266-LOtherLICENSE TO PRACTICE PSYCH
PAJA763904OtherBLUE SHIELD PROVIDER #