Provider Demographics
NPI:1396126769
Name:UTTAL, LYNET (LCSW, MSW, PHD, BS)
Entity type:Individual
Prefix:
First Name:LYNET
Middle Name:
Last Name:UTTAL
Suffix:
Gender:F
Credentials:LCSW, MSW, PHD, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 KESSEL CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-6200
Mailing Address - Country:US
Mailing Address - Phone:608-280-2672
Mailing Address - Fax:
Practice Address - Street 1:49 KESSEL CT
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-6200
Practice Address - Country:US
Practice Address - Phone:608-280-2672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9374-1231041C0700X
1041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical