Provider Demographics
NPI:1326161738
Name:DYKES, FAWN JANETTE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:FAWN
Middle Name:JANETTE
Last Name:DYKES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:DE QUEEN
Mailing Address - State:AR
Mailing Address - Zip Code:71832-3923
Mailing Address - Country:US
Mailing Address - Phone:870-642-5867
Mailing Address - Fax:
Practice Address - Street 1:1115 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:DE QUEEN
Practice Address - State:AR
Practice Address - Zip Code:71832-3923
Practice Address - Country:US
Practice Address - Phone:870-642-5867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP8007235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist