Provider Demographics
NPI:1740391101
Name:TYLKE, LYNNE K (PHD)
Entity Type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:K
Last Name:TYLKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-3901
Mailing Address - Country:US
Mailing Address - Phone:312-201-8565
Mailing Address - Fax:312-201-8564
Practice Address - Street 1:333 N MICHIGAN AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-3901
Practice Address - Country:US
Practice Address - Phone:312-201-8565
Practice Address - Fax:312-201-8564
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016 73466 22OtherBCBS PROVIDER NUMBER
IL333310Medicare ID - Type UnspecifiedPROVIDER NUMBER