Provider Demographics
NPI:1780705459
Name:DYSON, CORRIE J (MS)
Entity type:Individual
Prefix:
First Name:CORRIE
Middle Name:J
Last Name:DYSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W. COLLEGE AVENUE
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:TX
Mailing Address - Zip Code:76856
Mailing Address - Country:US
Mailing Address - Phone:214-500-9365
Mailing Address - Fax:325-597-1580
Practice Address - Street 1:2201 MENARD HWY
Practice Address - Street 2:
Practice Address - City:BRADY
Practice Address - State:TX
Practice Address - Zip Code:76825-7432
Practice Address - Country:US
Practice Address - Phone:325-597-1580
Practice Address - Fax:325-597-1580
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist