Provider Demographics
NPI:1679651616
Name:LANDE, LYNNE P (MSW, DCSW)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:P
Last Name:LANDE
Suffix:
Gender:F
Credentials:MSW, DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 E JOY RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9607
Mailing Address - Country:US
Mailing Address - Phone:734-649-0583
Mailing Address - Fax:
Practice Address - Street 1:2890 CARPENTER RD
Practice Address - Street 2:SUITE 1600
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1100
Practice Address - Country:US
Practice Address - Phone:734-677-0609
Practice Address - Fax:734-677-3072
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010213291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2141959OtherCIGNA
MI8008937590OtherBCBS