Provider Demographics
NPI:1497920755
Name:DYKES, ANGELA D (SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:D
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 1:161 MAGNOLIA RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39443-9557
Mailing Address - Country:US
Mailing Address - Phone:601-649-3860
Mailing Address - Fax:601-428-1754
Practice Address - Street 1:161 MAGNOLIA RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39443-9557
Practice Address - Country:US
Practice Address - Phone:601-649-3860
Practice Address - Fax:601-428-1754
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS2139235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00120631Medicaid