Provider Demographics
NPI:1073067260
Name:DULL, DAVA ALYXANDRA
Entity Type:Individual
Prefix:
First Name:DAVA
Middle Name:ALYXANDRA
Last Name:DULL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 W 2ND ST APT 3319
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64105-2179
Mailing Address - Country:US
Mailing Address - Phone:660-492-7533
Mailing Address - Fax:
Practice Address - Street 1:3600 NE RALPH POWELL RD STE E
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-2313
Practice Address - Country:US
Practice Address - Phone:816-228-8393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist