Provider Demographics
NPI:1497398044
Name:FLYNN TINSLEY, NANCY ELAINE (MA-CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ELAINE
Last Name:FLYNN TINSLEY
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 1:1883 W HAWLEY RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49454-9726
Mailing Address - Country:US
Mailing Address - Phone:231-843-8430
Mailing Address - Fax:
Practice Address - Street 1:1505 E PARKDALE AVE
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-9319
Practice Address - Country:US
Practice Address - Phone:231-723-2543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101000171235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist