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General NPI Number Information
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NPI Number | 1639010887
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Entity Type | Individual
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Provider Name | LYNNAE RAE SIS MT-BC
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Gender | Female
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Dates
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Enumeration Date | 04/02/2026
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Last Update Date | 04/02/2026
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Provider Practice Location Address
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Address Line | 3720 N 124TH ST STE P
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City | WAUWATOSA
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State | WI
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Zip | 53222-2121
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Country | US
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Telephone | 262-289-1022
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Fax |
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Provider Business Mailing Address
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Address Line | 1543 S 83RD ST
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City | WEST ALLIS
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State | WI
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Zip | 53214-4428
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Country | US
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Telephone | 262-289-1022
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Fax |
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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 | 225A00000X
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Taxonomy Name | Music Therapist
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License Number | 11163
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License Number State | WI
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