Provider Demographics
NPI:1386699478
Name:JANSSEN, LYNN THERESE (ST)
Entity type:Individual
Prefix:MS
First Name:LYNN
Middle Name:THERESE
Last Name:JANSSEN
Suffix:
Gender:F
Credentials:ST
Other - Prefix:MRS
Other - First Name:LYNN
Other - Middle Name:JANSSEN
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1454 30TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1305
Mailing Address - Country:US
Mailing Address - Phone:515-223-6620
Mailing Address - Fax:515-223-9625
Practice Address - Street 1:1454 30TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1305
Practice Address - Country:US
Practice Address - Phone:515-223-6620
Practice Address - Fax:515-223-9625
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00788235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist