Provider Demographics
NPI:1790550473
Name:FLYNN, HEATHER (SLP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:FLYNN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 HONEY MESQUITE PATH
Mailing Address - Street 2:
Mailing Address - City:WILLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77318-1330
Mailing Address - Country:US
Mailing Address - Phone:281-546-6772
Mailing Address - Fax:
Practice Address - Street 1:334 HONEY MESQUITE PATH
Practice Address - Street 2:
Practice Address - City:WILLIS
Practice Address - State:TX
Practice Address - Zip Code:77318-1330
Practice Address - Country:US
Practice Address - Phone:281-546-6772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist