Provider Demographics
NPI:1639214810
Name:CROUCH, LYNN M (DT)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:M
Last Name:CROUCH
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-3121
Mailing Address - Country:US
Mailing Address - Phone:217-753-8265
Mailing Address - Fax:
Practice Address - Street 1:1912 S 5TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-3121
Practice Address - Country:US
Practice Address - Phone:217-753-8265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist