Provider Demographics
NPI:1083965529
Name:FLYNN, JANIS ELIZABETH (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:ELIZABETH
Last Name:FLYNN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 JERICHO RD
Mailing Address - Street 2:
Mailing Address - City:SCITUATE
Mailing Address - State:MA
Mailing Address - Zip Code:02066-3558
Mailing Address - Country:US
Mailing Address - Phone:781-545-6338
Mailing Address - Fax:781-545-6338
Practice Address - Street 1:126 JERICHO RD
Practice Address - Street 2:
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066-3558
Practice Address - Country:US
Practice Address - Phone:781-545-6338
Practice Address - Fax:781-545-6338
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA461235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist