Provider Demographics
NPI:1962795914
Name:CALLAWAY, LYNN (BC-HIS)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:CALLAWAY
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 N LA CANADA DR STE 90
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-3100
Mailing Address - Country:US
Mailing Address - Phone:520-399-3220
Mailing Address - Fax:520-399-2233
Practice Address - Street 1:170 N LA CANADA DR STE 90
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-3100
Practice Address - Country:US
Practice Address - Phone:520-399-3220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA7225237700000X
AZHADR10081237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist