Provider Demographics
NPI:1861011801
Name:FLYNN, MARY ELENORE NELLIE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARY ELENORE
Middle Name:NELLIE
Last Name:FLYNN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:NELLIE
Other - Middle Name:
Other - Last Name:FLYNN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:108 N ESSEX AVE
Mailing Address - Street 2:
Mailing Address - City:MARGATE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08402-1826
Mailing Address - Country:US
Mailing Address - Phone:609-289-2331
Mailing Address - Fax:
Practice Address - Street 1:407 W DELILAH RD
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-1207
Practice Address - Country:US
Practice Address - Phone:609-289-2331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL015044235Z00000X
NJ41YS01137800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist