Provider Demographics
NPI:1639327778
Name:WAHLE, LYNN B
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:B
Last Name:WAHLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 TATER ST
Mailing Address - Street 2:
Mailing Address - City:MONT VERNON
Mailing Address - State:NH
Mailing Address - Zip Code:03057-1308
Mailing Address - Country:US
Mailing Address - Phone:603-673-4273
Mailing Address - Fax:
Practice Address - Street 1:109 PONEMAH RD STE 8
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NH
Practice Address - Zip Code:03031-2834
Practice Address - Country:US
Practice Address - Phone:603-801-2791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist