Provider Demographics
NPI:1124590583
Name:MURPHY, LYNN BARBARA (MA/CCC/SP)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:BARBARA
Last Name:MURPHY
Suffix:
Gender:F
Credentials:MA/CCC/SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17647 POMERADO RD UNIT 138
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-1661
Mailing Address - Country:US
Mailing Address - Phone:916-768-2690
Mailing Address - Fax:
Practice Address - Street 1:17647 POMERADO RD UNIT 138
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-1661
Practice Address - Country:US
Practice Address - Phone:916-768-2690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP6825174H00000X, 235Z00000X, 405300000X
CA6825174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP6825Medicaid