1093824260 NPI number — WENDY DYAN DILLON SPEECH LANGUAGE PATH

Table of content: WENDY DYAN DILLON SPEECH LANGUAGE PATH (NPI 1093824260)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093824260 NPI number — WENDY DYAN DILLON SPEECH LANGUAGE PATH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DILLON
Provider First Name:
WENDY
Provider Middle Name:
DYAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SPEECH LANGUAGE PATH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NOLLEY
Provider Other First Name:
WENDY
Provider Other Middle Name:
DYAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
SPEECH LANGUAGE PATH
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093824260
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1134 EAST FINCASTLE TURNPIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH TAZEWELL
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-988-8765
Provider Business Mailing Address Fax Number:
540-988-8764

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1134 EAST FINCASTLE TURNPIKE
Provider Second Line Business Practice Location Address:
HEARTLAND REHABILITATION SERVICES
Provider Business Practice Location Address City Name:
NORTH TAZEWELL
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-988-8765
Provider Business Practice Location Address Fax Number:
540-988-8764
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  2202004772 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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