Provider Demographics
NPI:1891353546
Name:FLANAGAN, KYLIE L (MSSW)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:L
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 MAIN ST STE 606
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47708-1848
Mailing Address - Country:US
Mailing Address - Phone:812-853-9110
Mailing Address - Fax:812-759-9869
Practice Address - Street 1:101 NOAHS LN
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130
Practice Address - Country:US
Practice Address - Phone:812-284-1760
Practice Address - Fax:812-282-4316
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99093268A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker