Provider Demographics
NPI:1831279694
Name:ARIAS-FLYNN, JEANNETTE THERESA (MS)
Entity Type:Individual
Prefix:MS
First Name:JEANNETTE
Middle Name:THERESA
Last Name:ARIAS-FLYNN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:'JAY'
Other - Middle Name:T
Other - Last Name:ARIAS-FLYNN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:1095 MIDWAY RD
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-1115
Mailing Address - Country:US
Mailing Address - Phone:920-720-3700
Mailing Address - Fax:920-720-3806
Practice Address - Street 1:100 COUNTY RD B
Practice Address - Street 2:BEHAVIORAL HEALTH SHAWANO
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-7072
Practice Address - Country:US
Practice Address - Phone:920-720-2300
Practice Address - Fax:920-720-3806
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI787125101Y00000X
WI787-125104100000X
WILPC 787-125104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
11737276Other(CAQH)
WI39596000Medicaid
11737276OtherCAQH