Healthcare Provider Details

I. General information

NPI: 1790056570
Provider Name (Legal Business Name): LAURA FLYNN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 NE 83RD ST SUITE 1001
KANSAS CITY MO
64119-4400
US

IV. Provider business mailing address

3100 NE 83RD ST SUITE 1001
KANSAS CITY MO
64119-4400
US

V. Phone/Fax

Practice location:
  • Phone: 816-468-0400
  • Fax: 816-468-6623
Mailing address:
  • Phone: 816-468-0400
  • Fax: 816-468-6623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2011033589
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: