Provider Demographics
NPI:1700958295
Name:FLYNN, KATHERINE JANE (LPC, LADC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JANE
Last Name:FLYNN
Suffix:
Gender:F
Credentials:LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5009 EXCELSIOR BLVD STE 134
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-3049
Mailing Address - Country:US
Mailing Address - Phone:612-819-5326
Mailing Address - Fax:
Practice Address - Street 1:5009 EXCELSIOR BLVD STE 134
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-3049
Practice Address - Country:US
Practice Address - Phone:612-819-5326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN300107101YA0400X
MN00065101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)