Provider Demographics
NPI:1881276061
Name:KYZER, DAKOTA
Entity type:Individual
Prefix:
First Name:DAKOTA
Middle Name:
Last Name:KYZER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DAKOTA
Other - Middle Name:
Other - Last Name:HARDICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:112 N SHORE LN
Mailing Address - Street 2:
Mailing Address - City:LAKE ARIEL
Mailing Address - State:PA
Mailing Address - Zip Code:18436-4412
Mailing Address - Country:US
Mailing Address - Phone:570-616-2855
Mailing Address - Fax:
Practice Address - Street 1:112 N SHORE LN
Practice Address - Street 2:
Practice Address - City:LAKE ARIEL
Practice Address - State:PA
Practice Address - Zip Code:18436-4412
Practice Address - Country:US
Practice Address - Phone:570-616-2855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPSL001277235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist