Healthcare Provider Details

I. General information

NPI: 1710046669
Provider Name (Legal Business Name): GARY M FLYNN LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 W 5TH ST
WINONA MN
55987
US

IV. Provider business mailing address

PO BOX 323
WINONA MN
55987-0323
US

V. Phone/Fax

Practice location:
  • Phone: 507-454-3880
  • Fax: 507-474-0383
Mailing address:
  • Phone: 507-454-3880
  • Fax: 507-474-0383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7343
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: