Provider Demographics
NPI:1295043974
Name:DALLAS, BARBARA JANE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:JANE
Last Name:DALLAS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:779 ANSLEY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-3670
Mailing Address - Country:US
Mailing Address - Phone:269-470-5041
Mailing Address - Fax:
Practice Address - Street 1:779 ANSLEY DR
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-3670
Practice Address - Country:US
Practice Address - Phone:269-470-5041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ASHA 01097313235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist