Provider Demographics
NPI:1689268633
Name:LYNCH, CASSANDRA
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:LYNCH
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 1:24541 BAYLOR ST NE
Mailing Address - Street 2:
Mailing Address - City:STACY
Mailing Address - State:MN
Mailing Address - Zip Code:55079-4601
Mailing Address - Country:US
Mailing Address - Phone:651-786-9685
Mailing Address - Fax:
Practice Address - Street 1:24541 BAYLOR ST NE
Practice Address - Street 2:
Practice Address - City:STACY
Practice Address - State:MN
Practice Address - Zip Code:55079-4601
Practice Address - Country:US
Practice Address - Phone:651-786-9685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-21
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer