Provider Demographics
NPI:1235466749
Name:DYRENFORTH, JUDITH ANN (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:ANN
Last Name:DYRENFORTH
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:398 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-3537
Mailing Address - Country:US
Mailing Address - Phone:907-374-4911
Mailing Address - Fax:907-374-4934
Practice Address - Street 1:398 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-3537
Practice Address - Country:US
Practice Address - Phone:907-374-4911
Practice Address - Fax:907-374-4934
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP-1944235Z00000X
AK460235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist