Provider Demographics
NPI:1669664819
Name:DYER, ELIZABETH G (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:G
Last Name:DYER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1372 NEWBURY NECK RD.
Mailing Address - Street 2:
Mailing Address - City:SURRY
Mailing Address - State:ME
Mailing Address - Zip Code:04684
Mailing Address - Country:US
Mailing Address - Phone:207-356-8211
Mailing Address - Fax:
Practice Address - Street 1:1372 NEWBURY NECK RD
Practice Address - Street 2:
Practice Address - City:SURRY
Practice Address - State:ME
Practice Address - Zip Code:04684-3819
Practice Address - Country:US
Practice Address - Phone:207-356-8211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP7962355S0801X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME060791OtherANTHEM BCBS