Provider Demographics
NPI:1538434113
Name:FLYNN, SHANA MAUREEN (MSW, LICSWW)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:MAUREEN
Last Name:FLYNN
Suffix:
Gender:F
Credentials:MSW, LICSWW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1522 E SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55812-1634
Mailing Address - Country:US
Mailing Address - Phone:218-724-3122
Mailing Address - Fax:218-724-4041
Practice Address - Street 1:1522 E SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55812-1634
Practice Address - Country:US
Practice Address - Phone:218-724-3122
Practice Address - Fax:218-724-4041
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN191481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical