Doctor Name: | CANDACE ANN BOLTON-FLYNN |
NPI Number: | 1063519643 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S. |
License Number: | 1739-125 |
Business Practice Address: | 6058 S Chestnut St Suite 100 Platteville, WI - 538188947 |
Business Phone Number: | 6083424863 |
Business Fax Number: | |
Mailing Address: | 4590 Marsha Ln, POTOSI |
State: | WI |
Postal Code: | 538209683 |
Phone Number: | 6087632973 |
Fax Number: | |
NPI Enumeration Date: | 09/17/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 1739-125 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |