Healthcare Provider Details

I. General information

NPI: 1912295247
Provider Name (Legal Business Name): CHRISTINE LYNCH CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2011
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 BUCKINGHAM RD
GROSSE POINTE PARK MI
48230-1137
US

IV. Provider business mailing address

1265 BUCKINGHAM RD
GROSSE POINTE PARK MI
48230-1137
US

V. Phone/Fax

Practice location:
  • Phone: 313-671-5407
  • Fax:
Mailing address:
  • Phone: 313-671-5407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number31473
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12053512
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: