Doctor Name: | LISSETTE DIALS |
NPI Number: | 1346494523 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | SLP |
License Number: | SL009210 |
Business Practice Address: | 8575 Rixlew Ln Manassas, VA - 201093701 |
Business Phone Number: | 7032579770 |
Business Fax Number: | |
Mailing Address: | 4074 Westwind Dr, WOODBRIDGE |
State: | VA |
Postal Code: | 221935168 |
Phone Number: | 2156920847 |
Fax Number: | |
NPI Enumeration Date: | 11/14/2008 |
NPI Last Update Date: | 03/17/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SL009210 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | PA |
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 |