Healthcare Provider Details

I. General information

NPI: 1356069538
Provider Name (Legal Business Name): KATHERINE FERN FLYNN CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 10/04/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 HIGHWAY 169 N STE 100
NEW HOPE MN
55428-4044
US

IV. Provider business mailing address

4900 HIGHWAY 169 N STE 100
NEW HOPE MN
55428-4044
US

V. Phone/Fax

Practice location:
  • Phone: 612-877-8800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberCFDE-255
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: