Provider Demographics
NPI:1174884142
Name:LYNAM, CHRISTINE JEAN (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:JEAN
Last Name:LYNAM
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 SPRUCE LN
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-1362
Mailing Address - Country:US
Mailing Address - Phone:732-576-2055
Mailing Address - Fax:
Practice Address - Street 1:524 WARDELL RD
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07753-7305
Practice Address - Country:US
Practice Address - Phone:732-922-9330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00492500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist