Healthcare Provider Details

I. General information

NPI: 1326524430
Provider Name (Legal Business Name): KELSEY EDITA FLYNN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 N MCLEAN BLVD STE 1
ELGIN IL
60123-1782
US

IV. Provider business mailing address

2671 SEELEY ST
YORKVILLE IL
60560-2535
US

V. Phone/Fax

Practice location:
  • Phone: 847-695-3680
  • Fax:
Mailing address:
  • Phone: 517-617-3304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.026668
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: