Provider Demographics
NPI:1073747879
Name:SYZDEK, DOROTHY ANNETTE
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:ANNETTE
Last Name:SYZDEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:SYZDEK
Other - Last Name:COBB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1007 S TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-5407
Mailing Address - Country:US
Mailing Address - Phone:337-460-1047
Mailing Address - Fax:
Practice Address - Street 1:1007 S TEXAS ST
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-5407
Practice Address - Country:US
Practice Address - Phone:337-460-1047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5116235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist