Provider Demographics
NPI:1265952873
Name:CANNON, LYNN PERSICA (LMSW)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:PERSICA
Last Name:CANNON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:LYNN
Other - Middle Name:MARIE
Other - Last Name:PERSICA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:8444 S ESSEN HEIGHTS CT
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-2217
Mailing Address - Country:US
Mailing Address - Phone:225-771-8884
Mailing Address - Fax:225-771-8884
Practice Address - Street 1:923 EXECUTIVE PARK AVE STE 12
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-2000
Practice Address - Country:US
Practice Address - Phone:225-303-0212
Practice Address - Fax:225-355-1555
Is Sole Proprietor?:No
Enumeration Date:2017-06-24
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14381171M00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator