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General NPI Number Information
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NPI Number | 1659046290
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Entity Type | Individual
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Provider Name | ROSALIE LACHELLE LYNN
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Gender | Female
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Dates
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Enumeration Date | 08/16/2021
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 921 BROADUS ST STE B
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City | STURGIS
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State | MI
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Zip | 49091-2403
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Country | US
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Telephone | 833-624-6385
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Fax |
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Provider Business Mailing Address
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Address Line | 116 W SHERMAN WAY STE 1
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City | NIXA
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State | MO
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Zip | 65714-9022
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Country | US
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Telephone |
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-21-179295
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | 2022036295
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License Number State | MO
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