Provider Demographics
NPI:1508059783
Name:DRYER, HULDAH ISRAEL
Entity Type:Individual
Prefix:MISS
First Name:HULDAH
Middle Name:ISRAEL
Last Name:DRYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 N 3RD ST STE 300
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-5550
Mailing Address - Country:US
Mailing Address - Phone:740-349-7511
Mailing Address - Fax:
Practice Address - Street 1:15 N 3RD ST STE 300
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-5550
Practice Address - Country:US
Practice Address - Phone:740-349-7511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OHS09009271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program