Provider Demographics
NPI:1811470875
Name:FLYNN, JENNIFER J (MSOM, DIP OM, RAC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:FLYNN
Suffix:
Gender:F
Credentials:MSOM, DIP OM, RAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9015 AUSTIN RD
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-9652
Mailing Address - Country:US
Mailing Address - Phone:414-403-0150
Mailing Address - Fax:
Practice Address - Street 1:696 N MILL ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1452
Practice Address - Country:US
Practice Address - Phone:414-403-0150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5401000206171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist