MEDICARE: ELIZABETH FLYNN, PLLC

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	103T00000X	Psychologist		MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346795077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELIZABETH FLYNN, PLLC

Provider Business Mailing Address
First Line	:	401 19TH AVE N
Second Line	:
City	:	SARTELL
State	:	MN
Zip	:	56377-1680
Country	:	US
Telephone Number	:	320-493-3046
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 1ST ST N STE 300
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56303-1927
Country	:	US
Telephone Number	:	320-493-3046
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST
Name	:	DR. ELIZABETH JO FLYNN
Credential	:	PSY.D.
Telephone Number	:	320-493-3046

Provider Enumeration Date	:	08/23/2016
Last Update Date	:	08/23/2016

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