Provider Demographics
NPI:1265945414
Name:LYNCH, ANGELA (MA)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:LYNCH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:GRANET
Other - Last Name:LYNCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:2101 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-3657
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2101 16TH AVE
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-3657
Practice Address - Country:US
Practice Address - Phone:309-793-5995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1811360235Z00000X
IL146011295235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist