Provider Demographics
NPI:1659453165
Name:ROUTSONG-WIECHERS, LYNNE M (MSW, LISW)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:M
Last Name:ROUTSONG-WIECHERS
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8940 KINGSRIDGE DR
Mailing Address - Street 2:STE 106
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-1632
Mailing Address - Country:US
Mailing Address - Phone:937-432-9130
Mailing Address - Fax:937-432-9169
Practice Address - Street 1:8940 KINGSRIDGE DR
Practice Address - Street 2:STE 106
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45458-1632
Practice Address - Country:US
Practice Address - Phone:937-432-9130
Practice Address - Fax:937-432-9169
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI81671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000297240OtherANTHEM BC/BS