Individual provider Active NPI

Leianne Wilk Flynn, M.A., CCC-SLP

  • Speech-Language Pathologist
  • Everett, WA
National Provider Identifier
1043597750
Registry record updated Jan 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
60230416 Issued in WA
Practice address
906 SE Everett Mall Way Ste 200
Everett, WA 98208-3743
Phone
(425) 353-5656
Fax
(425) 513-0917
NPI assigned
Nov 8, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 60230416 WA Primary

Addresses

Primary practice location

906 SE Everett Mall Way Ste 200
Everett, WA 98208-3743

Mailing address

14 E Casino Rd Ste a
Everett, WA 98208-2628
Phone (425) 775-6070

Other identifiers 1

IdentifierTypeStateIssuer
2015213MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
60230416WAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Childstrive Speech-Language Pathologist CurrentSince Jan 12, 2020 Accepting new patients

Locations

906 SE Everett Mall Way
Ste 200
Everett, WA 98208
Phone (425) 353-5656

14 E Casino Rd
Ste A
Everett, WA 98208
Phone (425) 353-5656

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1320710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578355200000",
    "number": "1043597750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 E CASINO RD STE A",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982082628",
            "telephone_number": "425-775-6070",
            "fax_number": "425-513-0917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "906 SE EVERETT MALL WAY STE 200",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982083743",
            "telephone_number": "425-353-5656",
            "fax_number": "425-513-0917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLYNN",
        "first_name": "LEIANNE",
        "middle_name": "WILK",
        "name_prefix": "Ms.",
        "credential": "M.A., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-08",
        "last_updated": "2020-01-07",
        "certification_date": "2020-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WA",
            "license": "60230416",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2015213",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Everett, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.