Provider Demographics
NPI:1639539810
Name:LYMAN, JON M (HAD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:M
Last Name:LYMAN
Suffix:
Gender:M
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 S ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-1810
Mailing Address - Country:US
Mailing Address - Phone:406-549-1951
Mailing Address - Fax:406-542-5682
Practice Address - Street 1:317 S ORANGE ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-1810
Practice Address - Country:US
Practice Address - Phone:406-549-1951
Practice Address - Fax:406-542-5682
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTHAD-HAD-LIC-1211237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist