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General NPI Number Information
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NPI Number | 1326191925
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Entity Type | Individual
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Provider Name | SHANNON M LYNCH PH.D.
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Gender | Female
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | ISU PSYCHOLOGY CLINIC IDAHO STATE UNIVERSITY, STOP 8112
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City | POCATELLO
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State | ID
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Zip | 83209-0001
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Country | US
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Telephone | 208-282-2129
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Fax | 208-282-5411
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Provider Business Mailing Address
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Address Line | PSYCHOLOGY DEPARTMENT 921 SO 8TH AVE, STOP 8112
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City | POCATELLO
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State | ID
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Zip | 83209-0001
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Country | US
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Telephone | 208-282-2110
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Fax | 208-282-5411
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | PSY-202220
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License Number State | ID
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