Healthcare Provider Details

I. General information

NPI: 1174043756
Provider Name (Legal Business Name): SUSAN JANET FLYNN MS, NMBA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2153 GLADSTONE AVE
LOUISVILLE KY
40205-2564
US

IV. Provider business mailing address

2153 GLADSTONE AVE
LOUISVILLE KY
40205-2564
US

V. Phone/Fax

Practice location:
  • Phone: 502-418-4241
  • Fax:
Mailing address:
  • Phone: 502-418-4241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number139981
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: