Provider Demographics
NPI:1750300158
Name:SERVAIS, LYNN MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:MARIE
Last Name:SERVAIS
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 1:5000 NATIONAL AVENUE
Mailing Address - Street 2:DOM 123
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-5000
Mailing Address - Country:US
Mailing Address - Phone:414-384-2000
Mailing Address - Fax:414-382-5379
Practice Address - Street 1:5000 NATIONAL AVENUE
Practice Address - Street 2:DOM 123
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-5000
Practice Address - Country:US
Practice Address - Phone:414-384-2000
Practice Address - Fax:414-382-5379
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2565103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical