Healthcare Provider Details

I. General information

NPI: 1669874525
Provider Name (Legal Business Name): MICHELLE MARIE FLYNN M.S., CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1636 TOLEDANO ST
NEW ORLEANS LA
70115-4542
US

IV. Provider business mailing address

6320 DELORD ST
NEW ORLEANS LA
70118-6316
US

V. Phone/Fax

Practice location:
  • Phone: 504-866-2606
  • Fax:
Mailing address:
  • Phone: 504-897-2606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7169
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: