Healthcare Provider Details

I. General information

NPI: 1912016635
Provider Name (Legal Business Name): DALE TIMOTHY FLYNN MSPA CCCA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21616 76TH AVE W SUITE 112
EDMONDS WA
98026-7512
US

IV. Provider business mailing address

805 MADISON ST SUITE 901
SEATTLE WA
98104-1172
US

V. Phone/Fax

Practice location:
  • Phone: 425-775-6651
  • Fax: 425-670-6718
Mailing address:
  • Phone: 206-264-8100
  • Fax: 206-264-8689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberLD00001028
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: