Provider Demographics
NPI:1437364221
Name:GALLAGHER, LYNN MARIE (MA)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:MARIE
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 NEWBERRY
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48380-1712
Mailing Address - Country:US
Mailing Address - Phone:248-889-1847
Mailing Address - Fax:
Practice Address - Street 1:1630 NEWBERRY
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48380-1712
Practice Address - Country:US
Practice Address - Phone:248-379-7715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI01064346235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist