Healthcare Provider Details

I. General information

NPI: 1750990016
Provider Name (Legal Business Name): LINDSAY ALEXANDRA LYSZCZARZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5281 CLYDE PARK AVE SE SUITE 2
WYOMING MI
49509
US

IV. Provider business mailing address

332 WALLINWOOD AVE NE
GRAND RAPIDS MI
49503-3726
US

V. Phone/Fax

Practice location:
  • Phone: 616-719-4263
  • Fax:
Mailing address:
  • Phone: 248-724-8431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: