Healthcare Provider Details

I. General information

NPI: 1912910381
Provider Name (Legal Business Name): PATRICK MICHAEL FLYNN MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6058 S CHESTNUT ST SUITE 100
PLATTEVILLE WI
53818-8947
US

IV. Provider business mailing address

4590 MARSHA LN
POTOSI WI
53820-9683
US

V. Phone/Fax

Practice location:
  • Phone: 608-342-4863
  • Fax:
Mailing address:
  • Phone: 608-763-2973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: