Provider Demographics
NPI:1801035290
Name:LYNCH, KATHLEEN (DT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:LYNCH
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 FIELDING DR
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-7759
Mailing Address - Country:US
Mailing Address - Phone:847-998-9121
Mailing Address - Fax:
Practice Address - Street 1:1712 FIELDING DR
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-7759
Practice Address - Country:US
Practice Address - Phone:847-998-9121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist