Provider Demographics
NPI:1427026988
Name:FLYNN, ANDREW MEADE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:MEADE
Last Name:FLYNN
Suffix:
Gender:M
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7464 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63143-3030
Mailing Address - Country:US
Mailing Address - Phone:910-619-8565
Mailing Address - Fax:866-453-9441
Practice Address - Street 1:7464 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MO
Practice Address - Zip Code:63143-3030
Practice Address - Country:US
Practice Address - Phone:910-619-8565
Practice Address - Fax:866-453-9441
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6417235Z00000X
IL146012446235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412532Medicaid