Provider Demographics
NPI:1336445501
Name:LYONS, CHERYL LYNN (CSAC , ICS)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:LYONS
Suffix:
Gender:F
Credentials:CSAC , ICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2914 INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-4047
Mailing Address - Country:US
Mailing Address - Phone:608-223-3311
Mailing Address - Fax:608-223-3304
Practice Address - Street 1:2914 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-4047
Practice Address - Country:US
Practice Address - Phone:608-223-3311
Practice Address - Fax:608-223-3304
Is Sole Proprietor?:No
Enumeration Date:2011-02-04
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15138-132101YA0400X
WI15370-134101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)