Provider Demographics
NPI:1760608822
Name:KIRBY, LYNN ANTONEITTE (SLP)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:ANTONEITTE
Last Name:KIRBY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 BRIDGESTONE CV
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:TN
Mailing Address - Zip Code:38355
Mailing Address - Country:US
Mailing Address - Phone:731-217-8694
Mailing Address - Fax:
Practice Address - Street 1:1900 PARR AVE
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-2009
Practice Address - Country:US
Practice Address - Phone:731-286-1221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3106235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist