Provider Demographics
NPI:1821895053
Name:ENTWISTLE, DANA MARIE (MS, CCC-SLP, CLC)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:MARIE
Last Name:ENTWISTLE
Suffix:
Gender:
Credentials:MS, CCC-SLP, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17427 SUMMERS WALK BLVD
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-8948
Mailing Address - Country:US
Mailing Address - Phone:919-771-6402
Mailing Address - Fax:
Practice Address - Street 1:1001 BLYTHE BLVD FL 5
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5866
Practice Address - Country:US
Practice Address - Phone:704-381-3313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12432235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist