Provider Demographics
NPI:1417346255
Name:EWBANK, DANA LYNN (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:LYNN
Last Name:EWBANK
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 1:1232 DUNWICH DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-3042
Mailing Address - Country:US
Mailing Address - Phone:816-695-1362
Mailing Address - Fax:
Practice Address - Street 1:2201 GLENN HENDREN DR
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-3375
Practice Address - Country:US
Practice Address - Phone:816-792-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007016422235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist