Provider Demographics
NPI:1053963116
Name:LYNCH, JENNA (MA, CF-SLP)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:LYNCH
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11312 SW CARMON RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:KS
Mailing Address - Zip Code:67010-8627
Mailing Address - Country:US
Mailing Address - Phone:316-201-8444
Mailing Address - Fax:
Practice Address - Street 1:11312 SW CARMON RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:KS
Practice Address - Zip Code:67010-8627
Practice Address - Country:US
Practice Address - Phone:316-201-8444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist