Provider Demographics
NPI:1912294901
Name:VEDIN, LYNNE ALLYCE (LLPC)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:ALLYCE
Last Name:VEDIN
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:LYNNE
Other - Middle Name:ALLYCE
Other - Last Name:SHEFFLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLPC
Mailing Address - Street 1:200 W SPRING ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4630
Mailing Address - Country:US
Mailing Address - Phone:906-225-7210
Mailing Address - Fax:906-225-7282
Practice Address - Street 1:200 W SPRING ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4630
Practice Address - Country:US
Practice Address - Phone:906-225-7210
Practice Address - Fax:906-225-7282
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011687101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional