Provider Demographics
NPI:1194899039
Name:VEDRINE, LYNETTE ANN (PSYD)
Entity type:Individual
Prefix:DR
First Name:LYNETTE
Middle Name:ANN
Last Name:VEDRINE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:666 DUNDEE RD
Mailing Address - Street 2:1302
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2727
Mailing Address - Country:US
Mailing Address - Phone:847-400-5824
Mailing Address - Fax:847-400-5828
Practice Address - Street 1:666 DUNDEE RD
Practice Address - Street 2:1302
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2727
Practice Address - Country:US
Practice Address - Phone:847-400-5824
Practice Address - Fax:847-400-5828
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004949103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL581460Medicare ID - Type Unspecified