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General NPI Number Information
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NPI Number | 1104909860
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Entity Type | Organization
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Legal Business Name | LYNN M CENTER, INC
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 05/24/2016
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Provider Practice Location Address
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Address Line | 2580 E JOYCE BLVD SUITE 12
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-4553
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Country | US
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Telephone | 479-521-7337
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Fax | 479-521-7338
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Provider Business Mailing Address
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Address Line | 2580 E JOYCE BLVD SUITE 12
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-4553
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Country | US
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Telephone | 479-521-7337
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Fax | 479-521-7338
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Authorized Official
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Title or Position | SPEECH PATHOLOGIST/OWNER
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Name | MRS. LYNN MARIE CENTER
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Credential | SLP
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Telephone | 479-466-1580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP1480
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License Number State | AR
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