Provider Demographics
NPI:1548487390
Name:MERWIN JESEWITZ, LYNNE MERWIN (MA, LP)
Entity type:Individual
Prefix:MS
First Name:LYNNE
Middle Name:MERWIN
Last Name:MERWIN JESEWITZ
Suffix:
Gender:F
Credentials:MA, LP
Other - Prefix:
Other - First Name:LYNNE
Other - Middle Name:MERWIN
Other - Last Name:JESEWITZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7575 GOLDEN VALLEY RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4562
Mailing Address - Country:US
Mailing Address - Phone:763-525-8590
Mailing Address - Fax:763-525-8592
Practice Address - Street 1:7575 GOLDEN VALLEY RD
Practice Address - Street 2:SUITE 230
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4562
Practice Address - Country:US
Practice Address - Phone:763-525-8590
Practice Address - Fax:763-525-8592
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5168103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical