Healthcare Provider Details

I. General information

NPI: 1386111276
Provider Name (Legal Business Name): ARIELLE JOY FLYNN MS, LCGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. ARIELLE JOY JOHNSTON

II. Dates (important events)

Enumeration Date: 10/29/2018
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 N SEVENTH STREET
BISMARCK ND
58501
US

IV. Provider business mailing address

414 N SEVENTH STREET
BISMARCK ND
58501
US

V. Phone/Fax

Practice location:
  • Phone: 701-323-8854
  • Fax:
Mailing address:
  • Phone: 701-323-8854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number123
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: