Provider Demographics
NPI:1306975941
Name:WAELDE, LYNN CLARE (PHD)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:CLARE
Last Name:WAELDE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 E MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-4233
Mailing Address - Country:US
Mailing Address - Phone:650-843-3505
Mailing Address - Fax:650-493-6147
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:MC 5500
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-498-5710
Practice Address - Fax:650-498-5840
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 17311103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical