Individual
LYNETTE MEDLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1880 S UNION AVE C, OZARK, AL 36360, OZARK, AL 36360
(334) 443-1043
Mailing address
815 E LEE ST APT 7B, ENTERPRISE, AL 36330-2034
(133) 444-9132
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
21-193378
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5300012300198
—
AL
Enumeration date
05/06/2022
Last updated
05/06/2022
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