Provider Demographics
NPI:1326002890
Name:BROWN, LYNELL L (AUD)
Entity type:Individual
Prefix:
First Name:LYNELL
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:LYNELL
Other - Middle Name:L
Other - Last Name:DUNLAP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:BELOIT HEALTH SYSTEMS INC
Mailing Address - Street 2:1969 W HART ROAD
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-2230
Mailing Address - Country:US
Mailing Address - Phone:608-364-2293
Mailing Address - Fax:608-364-5525
Practice Address - Street 1:BELOIT CLINIC
Practice Address - Street 2:1905 E HUEBBE PARKWAY
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-1842
Practice Address - Country:US
Practice Address - Phone:608-364-2450
Practice Address - Fax:608-363-7376
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI330-156231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1326002890Medicaid
WI41138300Medicaid
WI7156OtherDEAN HEALTH INSURANCE
WI073574150Medicare PIN
WI41138300Medicaid
WI018754340Medicare PIN