Basic Information
| Provider Information | |||||||||
| NPI: | 1861011801 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLYNN | ||||||||
| FirstName: | MARY ELENORE | ||||||||
| MiddleName: | NELLIE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MS CCC-SLP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | FLYNN | ||||||||
| OtherFirstName: | NELLIE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 108 N ESSEX AVE | ||||||||
| Address2: | |||||||||
| City: | MARGATE CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 084021826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092892331 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 200 SKILES BLVD | ||||||||
| Address2: | |||||||||
| City: | WEST CHESTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193827321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005787906 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2020 | ||||||||
| LastUpdateDate: | 04/09/2020 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 04/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SL015044 | PA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.