Provider Demographics
NPI:1902516818
Name:FLYNN, BRIDGET COLLINS
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:COLLINS
Last Name:FLYNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 KATIE LN
Mailing Address - Street 2:
Mailing Address - City:PAINTED POST
Mailing Address - State:NY
Mailing Address - Zip Code:14870-9004
Mailing Address - Country:US
Mailing Address - Phone:607-684-3686
Mailing Address - Fax:
Practice Address - Street 1:165 CHARLES ST
Practice Address - Street 2:
Practice Address - City:PAINTED POST
Practice Address - State:NY
Practice Address - Zip Code:14870-1100
Practice Address - Country:US
Practice Address - Phone:607-936-3704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-01
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032646235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY032646OtherI WORK IN A SCHOOL DISTRICT.