Provider Demographics
NPI:1194154435
Name:FLYNN, KAILEIGH (BCABA)
Entity type:Individual
Prefix:
First Name:KAILEIGH
Middle Name:
Last Name:FLYNN
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 TALCOTT RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-2040
Mailing Address - Country:US
Mailing Address - Phone:802-662-7831
Mailing Address - Fax:
Practice Address - Street 1:37 TALCOTT RD
Practice Address - Street 2:SUITE 114
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-2040
Practice Address - Country:US
Practice Address - Phone:802-235-9322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0135640103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst