Provider Demographics
NPI:1326420936
Name:FLANAGAN, KENNETH (LCSW)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:FLANAGAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 PAGE DR S STE 202
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-3536
Mailing Address - Country:US
Mailing Address - Phone:701-353-9979
Mailing Address - Fax:701-212-1700
Practice Address - Street 1:1351 PAGE DR S STE 202
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3536
Practice Address - Country:US
Practice Address - Phone:701-353-9979
Practice Address - Fax:701-212-1700
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND44971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND4497OtherLICENSE