Provider Demographics
NPI:1669404075
Name:DREYER ENTERPRISES INC
Entity type:Organization
Organization Name:DREYER ENTERPRISES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DREYER
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:765-246-4088
Mailing Address - Street 1:89 50 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:FILLMORE
Mailing Address - State:IN
Mailing Address - Zip Code:46128-9205
Mailing Address - Country:US
Mailing Address - Phone:765-246-4088
Mailing Address - Fax:765-246-4088
Practice Address - Street 1:89 50 NORTH ST
Practice Address - Street 2:
Practice Address - City:FILLMORE
Practice Address - State:IN
Practice Address - Zip Code:46128-9205
Practice Address - Country:US
Practice Address - Phone:765-246-4088
Practice Address - Fax:765-246-4088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002854A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN22002854AOtherSPEECH PATHOLOGIST LICENS