Provider Demographics
NPI:1942711338
Name:DEDECKER, LYNN ANN (MS)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:ANN
Last Name:DEDECKER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 MASON AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-1200
Mailing Address - Country:US
Mailing Address - Phone:708-496-3330
Mailing Address - Fax:708-496-3920
Practice Address - Street 1:7600 MASON AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-1200
Practice Address - Country:US
Practice Address - Phone:708-496-3330
Practice Address - Fax:708-496-3920
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146002832235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist