Provider Demographics
NPI:1215483714
Name:FLINTA, ANDREA JAYNE
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:JAYNE
Last Name:FLINTA
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 1:1950 N MALLWAY DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-4326
Mailing Address - Country:US
Mailing Address - Phone:614-487-5180
Mailing Address - Fax:
Practice Address - Street 1:1780 BARRINGTON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-3839
Practice Address - Country:US
Practice Address - Phone:614-487-5180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-3551235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist