Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 1458057 | WI |
NPI | 1043239676 |
---|---|
Provider Name | Dr. Kerry Wayne Lynch |
First Address | Milwaukee, WI 53295-0001 |
Second Address | Ixonia, WI 53036 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14580057 | PSYCHOLOGIST (01) | WI |