Provider Demographics
NPI:1437603925
Name:FLYNN, BRANDY (SLP)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:FLYNN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12257 BREEZEWAY CIR
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-4010
Mailing Address - Country:US
Mailing Address - Phone:228-313-0542
Mailing Address - Fax:
Practice Address - Street 1:12257 BREEZEWAY CIR
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4010
Practice Address - Country:US
Practice Address - Phone:228-313-0542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3843235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist