Provider Demographics
NPI:1841710407
Name:LYNCH, JESSE
Entity type:Individual
Prefix:MR
First Name:JESSE
Middle Name:
Last Name:LYNCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:872 MUNSON AVE STE D
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3638
Mailing Address - Country:US
Mailing Address - Phone:231-938-3111
Mailing Address - Fax:
Practice Address - Street 1:872 MUNSON AVE STE D
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3638
Practice Address - Country:US
Practice Address - Phone:231-938-3111
Practice Address - Fax:231-938-3214
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501008569237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist