MEDICARE: EMMA-LEIGH SUE FLYNN ED.S

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	103TS0200X	School Psychologist	351718	CO

General Provider Information

NPI Number	:	1578233185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMA-LEIGH SUE FLYNN ED.S

Provider Business Mailing Address
First Line	:	417 SKYWAY DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3913
Country	:	US
Telephone Number	:	260-330-1045
Fax Number	:

Provider Business Practice Location Address
First Line	:	417 SKYWAY DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3913
Country	:	US
Telephone Number	:	260-330-1045
Fax Number	:

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

Provider Enumeration Date	:	09/15/2021
Last Update Date	:	09/15/2021

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