Provider Demographics
NPI:1306124946
Name:FLYNN, JASON E (HIS)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:E
Last Name:FLYNN
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2464 HIGHWAY 22 STE B
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-8704
Mailing Address - Country:US
Mailing Address - Phone:563-316-6022
Mailing Address - Fax:
Practice Address - Street 1:2464 HIGHWAY 22 STE B
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-8704
Practice Address - Country:US
Practice Address - Phone:402-515-6857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE725332S00000X
IA077701237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10024974700Medicaid