Provider Demographics
NPI:1619564143
Name:FLANAGAN, CHARLES S
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:S
Last Name:FLANAGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 OCEAN BEACH HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-4082
Mailing Address - Country:US
Mailing Address - Phone:360-423-6700
Mailing Address - Fax:
Practice Address - Street 1:812 OCEAN BEACH HWY STE 300
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-4082
Practice Address - Country:US
Practice Address - Phone:360-423-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA0000671237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist