Provider Demographics
NPI:1073849188
Name:DINKELMAN, RANDI RENEE (ST)
Entity Type:Individual
Prefix:MRS
First Name:RANDI
Middle Name:RENEE
Last Name:DINKELMAN
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 10TH ST SE
Mailing Address - Street 2:SPEECH THERAPY DEPARTMENT
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-1251
Mailing Address - Country:US
Mailing Address - Phone:319-398-6881
Mailing Address - Fax:319-369-4577
Practice Address - Street 1:701 10TH ST SE
Practice Address - Street 2:SPEECH THERAPY DEPARTMENT
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-1251
Practice Address - Country:US
Practice Address - Phone:319-398-6881
Practice Address - Fax:319-369-4577
Is Sole Proprietor?:No
Enumeration Date:2009-10-23
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-009771235Z00000X
IA080846235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist