MEDICARE: LYNN DANIEL WILKERSON JR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		MD

General Provider Information

NPI Number	:	1659260412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN DANIEL WILKERSON JR.

Provider Business Mailing Address
First Line	:	1518 NOVEMBER CIR APT 304
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-6967
Country	:	US
Telephone Number	:	240-481-8304
Fax Number	:	240-481-8304

Provider Business Practice Location Address
First Line	:	1518 NOVEMBER CIR APT 304
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-6967
Country	:	US
Telephone Number	:	240-481-8304
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2025
Last Update Date	:	06/28/2025

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