Provider Demographics
NPI:1215443619
Name:GILBERT, LYNN M
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:GILBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1038 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-2502
Mailing Address - Country:US
Mailing Address - Phone:719-415-7022
Mailing Address - Fax:
Practice Address - Street 1:1155 KELLY JOHNSON BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3932
Practice Address - Country:US
Practice Address - Phone:719-415-7022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO951990511OtherDRIVERS LICENSE