Provider Demographics
NPI:1336734888
Name:FLASH, MCKENNA Y (MA,CCC, SLP)
Entity Type:Individual
Prefix:
First Name:MCKENNA
Middle Name:Y
Last Name:FLASH
Suffix:
Gender:F
Credentials:MA,CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-4029
Mailing Address - Country:US
Mailing Address - Phone:860-878-2362
Mailing Address - Fax:
Practice Address - Street 1:113 EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-4029
Practice Address - Country:US
Practice Address - Phone:860-878-2362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-06
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5188235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist