Individual
DR. LYNN A. BLACKBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-3666
Mailing address
10000 W INNOVATION DR, MILWAUKEE, WI 53226-4837
(414) 456-5006
(414) 456-6259
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
2664
WI
103G00000X
Clinical Neuropsychologist
PYR0372
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39074700
—
WI
01
—
6154255
UBH
—
Enumeration date
07/16/2006
Last updated
10/12/2007
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