Provider Demographics
NPI:1639279896
Name:TAPPAN, LYNNE ANNE (MA, LISW)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:ANNE
Last Name:TAPPAN
Suffix:
Gender:F
Credentials:MA, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3369 E BROAD ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1062
Mailing Address - Country:US
Mailing Address - Phone:614-231-8950
Mailing Address - Fax:
Practice Address - Street 1:3369 E BROAD ST
Practice Address - Street 2:SUITE C
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1062
Practice Address - Country:US
Practice Address - Phone:614-231-8950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00018921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI0001892OtherSOCIAL WORK LICENSE
R73519Medicare UPIN
TASW75674Medicare ID - Type Unspecified