Doctor Name: | MR. STEVEN JOHN DYKSTRA |
NPI Number: | 1023244423 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | SL 388 |
Business Practice Address: | 21 Wilbraham Street Office 212 Palmer, MA - 010692100 |
Business Phone Number: | 4132836645 |
Business Fax Number: | 4132836645 |
Mailing Address: | 90 Beech St, PALMER |
State: | MA |
Postal Code: | 010692100 |
Phone Number: | 4132836645 |
Fax Number: | 4132836645 |
NPI Enumeration Date: | 06/01/2009 |
NPI Last Update Date: | 06/01/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SL 388 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |