Provider Demographics
NPI:1952702631
Name:FLYNN, TARA JEANNE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:TARA
Middle Name:JEANNE
Last Name:FLYNN
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Gender:F
Credentials:MS, CCC-SLP
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Mailing Address - Street 1:1535 RICHMOND AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1520
Mailing Address - Country:US
Mailing Address - Phone:718-556-1616
Mailing Address - Fax:718-442-9962
Practice Address - Street 1:1535 RICHMOND AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-1520
Practice Address - Country:US
Practice Address - Phone:718-556-1616
Practice Address - Fax:718-442-9962
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY024057-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist