Provider Demographics
NPI:1790011807
Name:DYKE-HILL, LISA ANTOINETTE (MS-CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANTOINETTE
Last Name:DYKE-HILL
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 1:5957 NW 79TH WAY
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-1116
Mailing Address - Country:US
Mailing Address - Phone:954-931-6011
Mailing Address - Fax:
Practice Address - Street 1:5957 NW 79TH WAY
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33067-1116
Practice Address - Country:US
Practice Address - Phone:954-931-6011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8078235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL205398932OtherIRS