Provider Demographics
NPI:1942242078
Name:LYNCH, JENNIFER MALLORY (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MALLORY
Last Name:LYNCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 W SALT CREEK LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-1069
Mailing Address - Country:US
Mailing Address - Phone:847-870-4780
Mailing Address - Fax:847-483-7447
Practice Address - Street 1:1786 MOON LAKE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1067
Practice Address - Country:US
Practice Address - Phone:847-884-7550
Practice Address - Fax:847-884-7510
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036115293208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics