Healthcare Provider Details

I. General information

NPI: 1093145088
Provider Name (Legal Business Name): LYNNE FLECK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2013
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5430 CRYSTAL LAKE DR APT 1L
EVANSVILLE IN
47715-5040
US

IV. Provider business mailing address

5430 CRYSTAL LAKE DR APT 1L
EVANSVILLE IN
47715-5040
US

V. Phone/Fax

Practice location:
  • Phone: 404-441-0490
  • Fax:
Mailing address:
  • Phone: 404-441-0490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW005459
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34011925A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: