Provider Demographics
NPI:1174698641
Name:FLANDERS, LYNNE M (LICSW)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:M
Last Name:FLANDERS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 23RD ST S
Mailing Address - Street 2:SUITE G
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-3707
Mailing Address - Country:US
Mailing Address - Phone:701-297-7540
Mailing Address - Fax:701-297-6439
Practice Address - Street 1:1308 23RD ST S
Practice Address - Street 2:SUITE G
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3707
Practice Address - Country:US
Practice Address - Phone:701-297-7540
Practice Address - Fax:701-297-6439
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND40131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGOtherUNITED BEHAVIORAL HEALTH
PENDINGOtherHEALTHPARTNERS
NDPENDINGMedicaid
PENDINGOtherMN BCBS
PENDINGOtherNDBCBS
PENDINGOtherNDBCBS