Provider Demographics
NPI:1780002022
Name:NEVINS, LYNN
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:NEVINS
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 1:603 W 111TH ST
Mailing Address - Street 2:APT 2W
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-1800
Mailing Address - Country:US
Mailing Address - Phone:248-931-3963
Mailing Address - Fax:
Practice Address - Street 1:603 W 111TH ST
Practice Address - Street 2:APT 2W
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1800
Practice Address - Country:US
Practice Address - Phone:248-931-3963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist