Provider Demographics
NPI:1013486554
Name:FLYNN, DIANE GREENFELD (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:GREENFELD
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 1:4511 BESTOR DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-2100
Mailing Address - Country:US
Mailing Address - Phone:240-740-2150
Mailing Address - Fax:301-871-0950
Practice Address - Street 1:4511 BESTOR DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20853-2100
Practice Address - Country:US
Practice Address - Phone:240-740-2150
Practice Address - Fax:301-871-0950
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01035235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist