Provider Demographics
NPI:1114087020
Name:FLYNN, DONNA J (LICSW LW00006426 WA)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:J
Last Name:FLYNN
Suffix:
Gender:F
Credentials:LICSW LW00006426 WA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2370 130TH AVE. N. E., SUITE 106
Mailing Address - Street 2:B
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005
Mailing Address - Country:US
Mailing Address - Phone:206-351-2689
Mailing Address - Fax:206-622-2008
Practice Address - Street 1:2370 130TH AVE. N.E., SUITE 106
Practice Address - Street 2:STE 230
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2699
Practice Address - Country:US
Practice Address - Phone:206-351-2689
Practice Address - Fax:206-282-0051
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000064261041C0700X, 101Y00000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8868038Medicare PIN