Provider Demographics
NPI:1871897579
Name:FLYNN, KATHLEEN DANIELLE (LMP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:DANIELLE
Last Name:FLYNN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19085 HARRIS ST NE
Mailing Address - Street 2:
Mailing Address - City:SUQUAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98392-9786
Mailing Address - Country:US
Mailing Address - Phone:509-429-7367
Mailing Address - Fax:
Practice Address - Street 1:1050 HILDEBRAND LN NE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2863
Practice Address - Country:US
Practice Address - Phone:206-842-4903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60192667225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist