Provider Demographics
NPI:1437142726
Name:BENNETT, DYANN DYER (MS)
Entity Type:Individual
Prefix:MRS
First Name:DYANN
Middle Name:DYER
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5020 E 68TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3307
Mailing Address - Country:US
Mailing Address - Phone:918-492-3636
Mailing Address - Fax:918-494-8915
Practice Address - Street 1:5020 E 68TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3307
Practice Address - Country:US
Practice Address - Phone:918-492-3636
Practice Address - Fax:918-494-8915
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist