Provider Demographics
NPI:1568608776
Name:FLANAGAN, JASON (CGC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:FLANAGAN
Suffix:
Gender:M
Credentials:CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 W 22ND ST
Mailing Address - Street 2:401
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-7702
Mailing Address - Country:US
Mailing Address - Phone:605-328-4600
Mailing Address - Fax:605-328-4601
Practice Address - Street 1:1500 W 22ND ST
Practice Address - Street 2:401
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-7702
Practice Address - Country:US
Practice Address - Phone:605-328-4600
Practice Address - Fax:605-328-4601
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS