Provider Demographics
NPI:1356633796
Name:FLYNN, GILLIAN DIANE (MS SLP CCC)
Entity Type:Individual
Prefix:MRS
First Name:GILLIAN
Middle Name:DIANE
Last Name:FLYNN
Suffix:
Gender:F
Credentials:MS SLP CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 TIOGA TER
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-1060
Mailing Address - Country:US
Mailing Address - Phone:518-378-8247
Mailing Address - Fax:
Practice Address - Street 1:8 TIOGA TER
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-1060
Practice Address - Country:US
Practice Address - Phone:518-378-8247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014352-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist