Healthcare Provider Details

I. General information

NPI: 1417934613
Provider Name (Legal Business Name): JANIS HINDS FLYNN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 IRELAND AVE IRELAND ARMY COMMUNITY HOSPITAL
FORT KNOX KY
40121-5111
US

IV. Provider business mailing address

530 MIDWAY RD
GUSTON KY
40142-7226
US

V. Phone/Fax

Practice location:
  • Phone: 502-624-9234
  • Fax:
Mailing address:
  • Phone: 270-422-3481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1316
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: