Healthcare Provider Details

I. General information

NPI: 1255293676
Provider Name (Legal Business Name): IVY M FLYNN LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 W OHIO PIKE
AMELIA OH
45102-9306
US

IV. Provider business mailing address

1548 WITTEKIND TER
CINCINNATI OH
45224-2153
US

V. Phone/Fax

Practice location:
  • Phone: 513-232-8100
  • Fax:
Mailing address:
  • Phone: 513-509-7309
  • Fax: 513-509-7309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1500099
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: