Healthcare Provider Details

I. General information

NPI: 1063139251
Provider Name (Legal Business Name): ROBERT DANIEL LYNN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 HOLLISTER CT
SAINT PETERS MO
63376-7837
US

IV. Provider business mailing address

94 HOLLISTER CT
SAINT PETERS MO
63376-7837
US

V. Phone/Fax

Practice location:
  • Phone: 314-305-0041
  • Fax: 314-338-4159
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2023032435
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: