Provider Demographics
NPI:1578233185
Name:FLYNN, EMMA-LEIGH SUE (EDS)
Entity Type:Individual
Prefix:
First Name:EMMA-LEIGH
Middle Name:SUE
Last Name:FLYNN
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 SKYWAY DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3913
Mailing Address - Country:US
Mailing Address - Phone:260-330-1045
Mailing Address - Fax:
Practice Address - Street 1:417 SKYWAY DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3913
Practice Address - Country:US
Practice Address - Phone:260-330-1045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO351718103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool