MEDICARE: TIMOTHY FLYNN M.S., CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLP001209	DC
2	235Z00000X	Speech-Language Pathologist	06312	MD
3	235Z00000X	Speech-Language Pathologist	2202006613	VA

General Provider Information

NPI Number	:	1285113886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY FLYNN M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	3313 WYNDHAM CIR APT 2207
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22302-4320
Country	:	US
Telephone Number	:	301-787-0316
Fax Number	:

Provider Business Practice Location Address
First Line	:	3313 WYNDHAM CIR APT 2207
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22302-4320
Country	:	US
Telephone Number	:	301-787-0316
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2018
Last Update Date	:	08/14/2018

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Directions to “ TIMOTHY FLYNN M.S., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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