Provider Demographics
NPI:1063629418
Name:DYKES SPEECH ASSOCIATES
Entity Type:Organization
Organization Name:DYKES SPEECH ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER SLP
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:D
Authorized Official - Last Name:DYKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-649-3860
Mailing Address - Street 1:161 MAGNOLIA RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39443-9557
Mailing Address - Country:US
Mailing Address - Phone:601-649-3860
Mailing Address - Fax:601-428-1754
Practice Address - Street 1:161 MAGNOLIA RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39443-9557
Practice Address - Country:US
Practice Address - Phone:601-649-3860
Practice Address - Fax:601-428-1754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS2139235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015335Medicaid