Provider Demographics
NPI:1689289274
Name:FLINNER, KATRINA L (MA)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:L
Last Name:FLINNER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:L
Other - Last Name:PUCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4117 TOP SEED DR APT 201
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-4824
Mailing Address - Country:US
Mailing Address - Phone:757-822-8917
Mailing Address - Fax:
Practice Address - Street 1:1413 LASKIN RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-6007
Practice Address - Country:US
Practice Address - Phone:757-263-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2203000844235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist