Provider Demographics
NPI:1043597750
Name:FLYNN, LEIANNE WILK (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LEIANNE
Middle Name:WILK
Last Name:FLYNN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:14 E CASINO RD STE A
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-2628
Mailing Address - Country:US
Mailing Address - Phone:425-775-6070
Mailing Address - Fax:425-513-0917
Practice Address - Street 1:906 SE EVERETT MALL WAY STE 200
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-3743
Practice Address - Country:US
Practice Address - Phone:425-353-5656
Practice Address - Fax:425-513-0917
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60230416235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2015213Medicaid