Provider Demographics
NPI:1326068065
Name:DWYER, JOANNE LYNN (AUD, MS, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:LYNN
Last Name:DWYER
Suffix:
Gender:F
Credentials:AUD, MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 406153
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1876
Mailing Address - Country:US
Mailing Address - Phone:609-886-4700
Mailing Address - Fax:609-653-8465
Practice Address - Street 1:1500 ROUTE 47
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:NJ
Practice Address - Zip Code:08242-1400
Practice Address - Country:US
Practice Address - Phone:609-886-4700
Practice Address - Fax:609-886-4747
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00025200231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7130503Medicaid
NJ161747DP9Medicare PIN