Provider Demographics
NPI:1285848150
Name:DYKINGA, MAUREEN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:DYKINGA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12316 N CLOUD RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-6560
Mailing Address - Country:US
Mailing Address - Phone:520-237-2850
Mailing Address - Fax:
Practice Address - Street 1:4570 N 1ST AVE
Practice Address - Street 2:STE 120
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-8601
Practice Address - Country:US
Practice Address - Phone:520-237-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZSLP1856235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist