| Doctor Name: | LYNAE MCMILLEN DICKEYTESDALL |
| NPI Number: | 1851769798 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 074799 |
| Business Practice Address: | 1800 19th St Rock Valley, IA - 512471058 |
| Business Phone Number: | 7124763281 |
| Business Fax Number: | 7124762970 |
| Mailing Address: | 1800 19th St, Po Box 70 ROCK VALLEY |
| State: | IA |
| Postal Code: | 512471058 |
| Phone Number: | 7124763281 |
| Fax Number: | 7124762970 |
| NPI Enumeration Date: | 09/09/2015 |
| NPI Last Update Date: | 09/09/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 074799 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |