Healthcare Provider Details

I. General information

NPI: 1285113886
Provider Name (Legal Business Name): TIMOTHY FLYNN M.S., CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3313 WYNDHAM CIR APT 2207
ALEXANDRIA VA
22302-4320
US

IV. Provider business mailing address

3313 WYNDHAM CIR APT 2207
ALEXANDRIA VA
22302-4320
US

V. Phone/Fax

Practice location:
  • Phone: 301-787-0316
  • Fax:
Mailing address:
  • Phone: 301-787-0316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP001209
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number06312
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202006613
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: