Provider Demographics
NPI:1245661834
Name:MANNY FLYNN, JESSICA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MANNY FLYNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 POYNTZ AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-6387
Mailing Address - Country:US
Mailing Address - Phone:785-775-1100
Mailing Address - Fax:785-409-6301
Practice Address - Street 1:323 POYNTZ AVE STE 101
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-6387
Practice Address - Country:US
Practice Address - Phone:785-775-1100
Practice Address - Fax:785-409-6301
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-06
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical