Healthcare Provider Details

I. General information

NPI: 1063606671
Provider Name (Legal Business Name): ANN ELIZABETH FLANINGAN M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANN ELIZABETH GRUVER

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 09/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2675 COURT DR
GASTONIA NC
28054-1478
US

IV. Provider business mailing address

2675 COURT DR
GASTONIA NC
28054-1478
US

V. Phone/Fax

Practice location:
  • Phone: 304-424-4150
  • Fax: 304-424-4151
Mailing address:
  • Phone: 304-424-4150
  • Fax: 304-424-4151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA 01375
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number9715
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9716
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: