Healthcare Provider Details

I. General information

NPI: 1770996639
Provider Name (Legal Business Name): KELLI-ANN FLYNN M.S., CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 06/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7030 SMOKE RANCH RD
LAS VEGAS NV
89128-1202
US

IV. Provider business mailing address

7030 SMOKE RANCH RD
LAS VEGAS NV
89128-1202
US

V. Phone/Fax

Practice location:
  • Phone: 702-979-4268
  • Fax:
Mailing address:
  • Phone: 702-979-4268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP-1707
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: