Provider Demographics
NPI:1114295656
Name:FLYNN, ADRIENE MICHELLE (MS, CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:MRS
First Name:ADRIENE
Middle Name:MICHELLE
Last Name:FLYNN
Suffix:
Gender:F
Credentials:MS, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 FRANKLIN PL
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-2144
Mailing Address - Country:US
Mailing Address - Phone:914-738-3434
Mailing Address - Fax:
Practice Address - Street 1:18 FRANKLIN PL
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NY
Practice Address - Zip Code:10803-2144
Practice Address - Country:US
Practice Address - Phone:914-738-3434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019417235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist