Provider Demographics
NPI:1972731487
Name:THIBEAULT-LAJOIE, LYNN A
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:A
Last Name:THIBEAULT-LAJOIE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LYNN
Other - Middle Name:A
Other - Last Name:THIBEAULT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:194 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORT KENT
Mailing Address - State:ME
Mailing Address - Zip Code:04743-1428
Mailing Address - Country:US
Mailing Address - Phone:207-834-1573
Mailing Address - Fax:207-834-4048
Practice Address - Street 1:3 MOUNTAINVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:FORT KENT
Practice Address - State:ME
Practice Address - Zip Code:04743-9977
Practice Address - Country:US
Practice Address - Phone:207-834-1573
Practice Address - Fax:207-834-4048
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME20333174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist