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General NPI Number Information
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NPI Number | 1093795106
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Entity Type | Organization
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Legal Business Name | LYNN E. NELSON, PSY.D., P.C.
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Dates
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Enumeration Date | 01/17/2006
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Last Update Date | 12/07/2009
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Provider Practice Location Address
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Address Line | 3330 OLD GLENVIEW RD SUITE 15
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City | WILMETTE
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State | IL
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Zip | 60091-2963
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Country | US
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Telephone | 847-857-0252
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Fax |
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Provider Business Mailing Address
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Address Line | 3330 OLD GLENVIEW RD SUITE 15
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City | WILMETTE
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State | IL
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Zip | 60091-2963
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Country | US
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Telephone | 847-857-0252
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LYNN E. NELSON
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Credential | PSY.D.
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Telephone | 847-204-1557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071004944
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License Number State | IL
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