Provider Demographics
NPI:1013153394
Name:LYNN, JENNIE (MA CCC/SLP)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:
Last Name:LYNN
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6152 CALM BREEZE AVE
Mailing Address - Street 2:UNIT 103
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-5192
Mailing Address - Country:US
Mailing Address - Phone:702-645-8243
Mailing Address - Fax:
Practice Address - Street 1:6152 CALM BREEZE AVE
Practice Address - Street 2:UNIT 103
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-5192
Practice Address - Country:US
Practice Address - Phone:702-645-8243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP694235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist