Provider Demographics
NPI:1205250388
Name:DENNIS, LINDA KATHERINE
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:KATHERINE
Last Name:DENNIS
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 1:118 GREENMOUNT BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-3140
Mailing Address - Country:US
Mailing Address - Phone:937-237-6350
Mailing Address - Fax:
Practice Address - Street 1:6061 OLD TROY PIKE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45424-3642
Practice Address - Country:US
Practice Address - Phone:937-237-6350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP6437235Z00000X
GASLP006581235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist