Provider Demographics
NPI:1891836854
Name:DUSOLD, LYNN MARIE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:MARIE
Last Name:DUSOLD
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11121 W OKLAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-4033
Mailing Address - Country:US
Mailing Address - Phone:262-641-9790
Mailing Address - Fax:262-641-9791
Practice Address - Street 1:13105 W BLUEMOUND RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-8022
Practice Address - Country:US
Practice Address - Phone:262-641-9790
Practice Address - Fax:262-641-9791
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2800-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39718500Medicare ID - Type Unspecified