Provider Demographics
NPI:1992708226
Name:FIRESTONE, LYNN M (AUD)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:M
Last Name:FIRESTONE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 WORTHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-1372
Mailing Address - Country:US
Mailing Address - Phone:860-633-5001
Mailing Address - Fax:
Practice Address - Street 1:21 SOUTH RD
Practice Address - Street 2:STE 112
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2410
Practice Address - Country:US
Practice Address - Phone:860-284-4940
Practice Address - Fax:860-284-4951
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT012231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4087294Medicaid
CT4087294Medicaid