Provider Demographics
NPI:1023485646
Name:FLINT, EMILIA SUE (PHD)
Entity type:Individual
Prefix:DR
First Name:EMILIA
Middle Name:SUE
Last Name:FLINT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:EMILIA
Other - Middle Name:SUE
Other - Last Name:BOESCHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:115 N 7TH ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-2700
Mailing Address - Country:US
Mailing Address - Phone:605-645-0100
Mailing Address - Fax:605-717-1009
Practice Address - Street 1:115 N 7TH ST
Practice Address - Street 2:SUITE 6
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-2700
Practice Address - Country:US
Practice Address - Phone:605-645-0100
Practice Address - Fax:605-717-1009
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD538103TC0700X, 103TC2200X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD2010722Medicaid
SDS110110Medicare PIN