Healthcare Provider Details

I. General information

NPI: 1972161453
Provider Name (Legal Business Name): JULIE MINTER FLYNN M.S. LEP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIE MINTER FLYNN M.S., LEP

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120A SANTA MARGARITA AVE
MENLO PARK CA
94025-2725
US

IV. Provider business mailing address

200 LYNDHURST AVE
BELMONT CA
94002-3712
US

V. Phone/Fax

Practice location:
  • Phone: 415-786-2533
  • Fax:
Mailing address:
  • Phone: 415-786-2533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number3578
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: