MEDICARE: MRS. LYNDE HOLSOMBACK ULMER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	3808	LA

General Provider Information

NPI Number	:	1346439882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LYNDE HOLSOMBACK ULMER LCSW

Provider Business Mailing Address
First Line	:	4521 JAMESTOWN AVE
Second Line	:	SUITE 2
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-3234
Country	:	US
Telephone Number	:	225-952-9210
Fax Number	:	225-952-9214

Provider Business Practice Location Address
First Line	:	4521 JAMESTOWN AVE
Second Line	:	SUITE 2
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-3234
Country	:	US
Telephone Number	:	225-952-9210
Fax Number	:	225-952-9214

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2007
Last Update Date	:	10/22/2007

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