Provider Demographics
NPI:1912016635
Name:FLYNN, DALE TIMOTHY (MSPA CCCA)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:TIMOTHY
Last Name:FLYNN
Suffix:
Gender:M
Credentials:MSPA CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 MADISON ST
Mailing Address - Street 2:SUITE 901
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1172
Mailing Address - Country:US
Mailing Address - Phone:206-264-8100
Mailing Address - Fax:206-264-8689
Practice Address - Street 1:21616 76TH AVE W SUITE 112
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7512
Practice Address - Country:US
Practice Address - Phone:425-775-6651
Practice Address - Fax:425-670-6718
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00001028231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8338444Medicaid
9002478OtherDSHS