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General NPI Number Information
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NPI Number | 1972161453
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Entity Type | Individual
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Provider Name | JULIE MINTER FLYNN M.S. LEP
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Gender | Female
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Dates
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Enumeration Date | 05/30/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 120A SANTA MARGARITA AVE
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City | MENLO PARK
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State | CA
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Zip | 94025-2725
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Country | US
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Telephone | 415-786-2533
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Fax |
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Provider Business Mailing Address
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Address Line | 200 LYNDHURST AVE
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City | BELMONT
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State | CA
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Zip | 94002-3712
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Country | US
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Telephone | 415-786-2533
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 3578
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License Number State | CA
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