Provider Demographics
NPI:1750595641
Name:WEBSTER, LYNN WYATT
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:WYATT
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 TREVILIAN WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-2157
Mailing Address - Country:US
Mailing Address - Phone:502-458-5761
Mailing Address - Fax:502-409-6425
Practice Address - Street 1:1920 TREVILIAN WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-2157
Practice Address - Country:US
Practice Address - Phone:502-458-5761
Practice Address - Fax:502-409-6425
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker