Provider Demographics
NPI:1043073455
Name:LYNCH, JENNIFER JEAN (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JEAN
Last Name:LYNCH
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 S PERRYVILLE RD STE 130
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2527
Mailing Address - Country:US
Mailing Address - Phone:815-396-8617
Mailing Address - Fax:815-201-8752
Practice Address - Street 1:555 S PERRYVILLE RD STE 130
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2527
Practice Address - Country:US
Practice Address - Phone:815-396-8617
Practice Address - Fax:815-201-8752
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-31
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2023206587363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health