Provider Demographics
NPI:1962017442
Name:FLYNN, ELYSE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:
Last Name:FLYNN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 ELDER TRL
Mailing Address - Street 2:
Mailing Address - City:BONNERDALE
Mailing Address - State:AR
Mailing Address - Zip Code:71933-6852
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:182 ELDER TRL
Practice Address - Street 2:
Practice Address - City:BONNERDALE
Practice Address - State:AR
Practice Address - Zip Code:71933-6852
Practice Address - Country:US
Practice Address - Phone:801-432-0748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2023-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13314853-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty