Provider Demographics
NPI:1346494523
Name:DIALS, LISSETTE (SLP)
Entity Type:Individual
Prefix:
First Name:LISSETTE
Middle Name:
Last Name:DIALS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:LISSETTE
Other - Middle Name:
Other - Last Name:BELEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:4074 WESTWIND DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-5168
Mailing Address - Country:US
Mailing Address - Phone:215-692-0847
Mailing Address - Fax:
Practice Address - Street 1:8575 RIXLEW LN
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-3701
Practice Address - Country:US
Practice Address - Phone:703-257-9770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009210235Z00000X
VA2202006443235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist