MEDICARE: JESSICA FLYNN

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	103TC1900X	Counseling Psychologist	10108245-2501	UT

General Provider Information

NPI Number	:	1730430257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA FLYNN

Provider Business Mailing Address
First Line	:	PO BOX 27128
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0128
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	395 W BULLDOG BLVD STE 601
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-3331
Country	:	US
Telephone Number	:	801-357-7525
Fax Number	:

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

Provider Enumeration Date	:	09/24/2012
Last Update Date	:	04/01/2019

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Directions to “ JESSICA FLYNN ” Practice Location

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