Provider Demographics
NPI:1679226724
Name:DYKE POLIVKA, ANGEL (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:DYKE POLIVKA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 N 200 W
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-1608
Mailing Address - Country:US
Mailing Address - Phone:812-219-7233
Mailing Address - Fax:
Practice Address - Street 1:890 N 200 W
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-1608
Practice Address - Country:US
Practice Address - Phone:812-219-7233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-29
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist