Provider Demographics
NPI:1982721692
Name:DYKES, WENDY (SLP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:DYKES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 OWEN KEMP RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-9481
Mailing Address - Country:US
Mailing Address - Phone:270-384-0436
Mailing Address - Fax:
Practice Address - Street 1:188 OWEN KEMP RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-9481
Practice Address - Country:US
Practice Address - Phone:270-384-0436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1925235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist