Provider Demographics
NPI:1528111630
Name:KEENAN, LYNN D (PHD, LMP)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:D
Last Name:KEENAN
Suffix:
Gender:F
Credentials:PHD, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 KLAHANNE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-8226
Mailing Address - Country:US
Mailing Address - Phone:360-565-1199
Mailing Address - Fax:
Practice Address - Street 1:401 E FRONT ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-3113
Practice Address - Country:US
Practice Address - Phone:360-565-1199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021304174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist