Provider Demographics
NPI:1124128228
Name:SWIGGUM, LYNN R (ATC, LAT)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:R
Last Name:SWIGGUM
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 S COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:FOX LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:53933-9414
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:705 S UNIVERSITY AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-3053
Practice Address - Country:US
Practice Address - Phone:920-885-2663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI449-039174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist