Healthcare Provider Details

I. General information

NPI: 1083229959
Provider Name (Legal Business Name): NEIL P LYNCH MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 W MEQUON RD
MEQUON WI
53092-3230
US

IV. Provider business mailing address

1655 W MEQUON ROAD
MEQUON WI
53092-3230
US

V. Phone/Fax

Practice location:
  • Phone: 414-292-4242
  • Fax: 262-240-9745
Mailing address:
  • Phone: 414-292-4242
  • Fax: 262-240-9745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: