Provider Demographics
NPI:1841519154
Name:DYMOND, RICK EDWARD
Entity type:Individual
Prefix:MR
First Name:RICK
Middle Name:EDWARD
Last Name:DYMOND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3665 28TH ST SE
Mailing Address - Street 2:SUITE 6D
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-1684
Mailing Address - Country:US
Mailing Address - Phone:616-285-6035
Mailing Address - Fax:616-285-6099
Practice Address - Street 1:3665 28TH ST SE
Practice Address - Street 2:SUITE 6D
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-1684
Practice Address - Country:US
Practice Address - Phone:616-285-6035
Practice Address - Fax:616-285-6099
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501002410237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist