1194899039 NPI number — DR. LYNETTE ANN VEDRINE PSY.D.

Table of content: DR. LYNETTE ANN VEDRINE PSY.D. (NPI 1194899039)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194899039 NPI number — DR. LYNETTE ANN VEDRINE PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VEDRINE
Provider First Name:
LYNETTE
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194899039
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
666 DUNDEE RD
Provider Second Line Business Mailing Address:
1302
Provider Business Mailing Address City Name:
NORTHBROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60062-2727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-400-5824
Provider Business Mailing Address Fax Number:
847-400-5828

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
666 DUNDEE RD
Provider Second Line Business Practice Location Address:
1302
Provider Business Practice Location Address City Name:
NORTHBROOK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60062-2727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-400-5824
Provider Business Practice Location Address Fax Number:
847-400-5828
Provider Enumeration Date:
11/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  071004949 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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