Basic Information
| Provider Information | |||||||||
| NPI: | 1538612247 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WARD | ||||||||
| FirstName: | LYNNELLE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 564 PINGREE CT | ||||||||
| Address2: | |||||||||
| City: | WATERFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483273075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897148433 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1685 BALDWIN AVE | ||||||||
| Address2: | |||||||||
| City: | PONTIAC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483401115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487063450 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2016 | ||||||||
| LastUpdateDate: | 07/28/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801092036 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.