Healthcare Provider Details

I. General information

NPI: 1346795077
Provider Name (Legal Business Name): ELIZABETH FLYNN, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2016
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 1ST ST N STE 300
SAINT CLOUD MN
56303-1927
US

IV. Provider business mailing address

401 19TH AVE N
SARTELL MN
56377-1680
US

V. Phone/Fax

Practice location:
  • Phone: 320-493-3046
  • Fax:
Mailing address:
  • Phone: 320-493-3046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateMN

VIII. Authorized Official

Name: DR. ELIZABETH JO FLYNN
Title or Position: LICENSED PSYCHOLOGIST
Credential: PSY.D.
Phone: 320-493-3046