Provider Demographics
NPI:1669595823
Name:ALVORD, LYNN STEPHEN (PHD)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:STEPHEN
Last Name:ALVORD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10588 S REDWOOD RD
Mailing Address - Street 2:STE B
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-8503
Mailing Address - Country:US
Mailing Address - Phone:586-323-2944
Mailing Address - Fax:313-916-1548
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:K-8, DIVISION OF AUDIOLOGY
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-9129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501004519237700000X
MI1601000078231H00000X
1601000078237600000X
UT104292-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI108888888Medicaid