Provider Demographics
NPI:1487940250
Name:LYNN FITZSIMMONS LLC
Entity type:Organization
Organization Name:LYNN FITZSIMMONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PH.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZSIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-861-2174
Mailing Address - Street 1:1482 W. WINDPOINTE COURT
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-1188
Mailing Address - Country:US
Mailing Address - Phone:414-861-2174
Mailing Address - Fax:
Practice Address - Street 1:216 GREEN BAY RD STE 108
Practice Address - Street 2:
Practice Address - City:THIENSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53092
Practice Address - Country:US
Practice Address - Phone:414-861-2174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-21
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2941057103T00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1629397815Medicaid