Provider Demographics
NPI:1588918015
Name:FLYNN, JESSICA M (LICSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:FLYNN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 WOODDALE AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-3240
Mailing Address - Country:US
Mailing Address - Phone:612-968-5790
Mailing Address - Fax:
Practice Address - Street 1:4800 OLSON MEMORIAL HWY STE 202
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-5169
Practice Address - Country:US
Practice Address - Phone:612-584-9908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-06
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN191031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical