1679600795 NPI number — PATRICIA KATHLEEN LYNCH LICSW

Table of content: SARAH HANNON M.S. (NPI 1134835630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679600795 NPI number — PATRICIA KATHLEEN LYNCH LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LYNCH
Provider First Name:
PATRICIA
Provider Middle Name:
KATHLEEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW
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:
1679600795
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
421 1ST AVE SW
Provider Second Line Business Mailing Address:
SUITE 200E
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55902-3383
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-289-5110
Provider Business Mailing Address Fax Number:
507-281-5335

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
421 1ST AVE SW
Provider Second Line Business Practice Location Address:
SUITE 200E
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55902-3383
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-289-5110
Provider Business Practice Location Address Fax Number:
507-281-5335
Provider Enumeration Date:
02/27/2007

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: 1041C0700X , with the licence number:  17704 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 044600900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 921001045655 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 137050 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP58827 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 83G10LY . This is a "BCBS OF MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 62-68292 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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