Healthcare Provider Details

I. General information

NPI: 1891223533
Provider Name (Legal Business Name): CYNTHIA K FLAMM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CYNTHIA K SULLIVAN LCSW

II. Dates (important events)

Enumeration Date: 05/25/2017
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 N MAIN ST
ANNA IL
62906-1668
US

IV. Provider business mailing address

513 N MAIN ST
ANNA IL
62906-1668
US

V. Phone/Fax

Practice location:
  • Phone: 618-833-4471
  • Fax: 618-833-8878
Mailing address:
  • Phone: 618-833-4471
  • Fax: 618-833-8878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149006971
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: