Provider Demographics
NPI:1629371877
Name:CONKLYN, DWYER B III (MT-BC)
Entity Type:Individual
Prefix:MR
First Name:DWYER
Middle Name:B
Last Name:CONKLYN
Suffix:III
Gender:M
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5145 E SPRAGUE RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-6231
Mailing Address - Country:US
Mailing Address - Phone:216-393-1939
Mailing Address - Fax:
Practice Address - Street 1:5145 E SPRAGUE RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-6231
Practice Address - Country:US
Practice Address - Phone:970-297-8506
Practice Address - Fax:216-834-2334
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-09
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist