Provider Demographics
NPI:1104135516
Name:BECKER, LYN
Entity type:Individual
Prefix:MRS
First Name:LYN
Middle Name:
Last Name:BECKER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LYN
Other - Middle Name:
Other - Last Name:BECKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCBA
Mailing Address - Street 1:212 DEER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62563-9221
Mailing Address - Country:US
Mailing Address - Phone:217-741-8247
Mailing Address - Fax:217-741-8247
Practice Address - Street 1:212 DEER CREEK RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:IL
Practice Address - Zip Code:62563-9221
Practice Address - Country:US
Practice Address - Phone:217-741-8247
Practice Address - Fax:217-741-8247
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-03
Last Update Date:2010-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-10-7043103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst