Provider Demographics
NPI:1043011497
Name:LYNDE, KOREY
Entity type:Individual
Prefix:
First Name:KOREY
Middle Name:
Last Name:LYNDE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-5901
Mailing Address - Country:US
Mailing Address - Phone:541-731-4898
Mailing Address - Fax:
Practice Address - Street 1:2727 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-5901
Practice Address - Country:US
Practice Address - Phone:541-731-4898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator