Healthcare Provider Details

I. General information

NPI: 1982181434
Provider Name (Legal Business Name): KATHRYN LEE FLYNN SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9943 E LAGUNA AZUL AVE
MESA AZ
85209-1481
US

IV. Provider business mailing address

9943 E LAGUNA AZUL AVE
MESA AZ
85209-1481
US

V. Phone/Fax

Practice location:
  • Phone: 602-790-8252
  • Fax:
Mailing address:
  • Phone: 602-790-8252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA11204
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: