Provider Demographics
NPI:1013206259
Name:DYER, JOANNA K (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:K
Last Name:DYER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:587 OLD TOWN WAY
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-1577
Mailing Address - Country:US
Mailing Address - Phone:781-982-1456
Mailing Address - Fax:
Practice Address - Street 1:587 OLD TOWN WAY
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-1577
Practice Address - Country:US
Practice Address - Phone:781-982-1456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6041235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist