MEDICARE: WILLIAM STUART LYNNE L.P.P.

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	103T00000X	Psychologist	KY-0023	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	184607	OTHER	KY	MEDICARE GROUP NUMBER

General Provider Information

NPI Number	:	1417901083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM STUART LYNNE L.P.P.

Provider Business Mailing Address
First Line	:	1643 N FORT THOMAS AVE
Second Line	:
City	:	FORT THOMAS
State	:	KY
Zip	:	41075-1118
Country	:	US
Telephone Number	:	859-816-4279
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 N FORT THOMAS AVE
Second Line	:
City	:	FORT THOMAS
State	:	KY
Zip	:	41075-3098
Country	:	US
Telephone Number	:	859-816-4279
Fax Number	:

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	03/17/2010

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