Healthcare Provider Details

I. General information

NPI: 1437087400
Provider Name (Legal Business Name): BROOKE LYNCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17315 BROOKGATE DR
ORLAND PARK IL
60467-7594
US

IV. Provider business mailing address

17315 BROOKGATE DR
ORLAND PARK IL
60467-7594
US

V. Phone/Fax

Practice location:
  • Phone: 503-544-4538
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: