Provider Demographics
NPI:1396054615
Name:LYN, STELLA (CLC)
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:
Last Name:LYN
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 SMALLWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99712-3124
Mailing Address - Country:US
Mailing Address - Phone:541-261-3537
Mailing Address - Fax:
Practice Address - Street 1:1075 SMALLWOOD TRL
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99712-3124
Practice Address - Country:US
Practice Address - Phone:541-261-3537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist