Healthcare Provider Details

I. General information

NPI: 1093702896
Provider Name (Legal Business Name): SIOBHAN LYNCH L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 WENDELL AVE
FAIRBANKS AK
99701
US

IV. Provider business mailing address

315 WENDELL AVE
FAIRBANKS AK
99701-4837
US

V. Phone/Fax

Practice location:
  • Phone: 907-452-6251
  • Fax: 907-452-1001
Mailing address:
  • Phone: 907-452-6251
  • Fax: 907-452-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSWS508
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: