Provider Demographics
NPI:1669874525
Name:FLYNN, MICHELLE MARIE (MS, CCC/SLP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:FLYNN
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6320 DELORD ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-6316
Mailing Address - Country:US
Mailing Address - Phone:504-897-2606
Mailing Address - Fax:
Practice Address - Street 1:1636 TOLEDANO ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-4542
Practice Address - Country:US
Practice Address - Phone:504-866-2606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7169235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist