Healthcare Provider Details

I. General information

NPI: 1033779764
Provider Name (Legal Business Name): NANCY ERIN DYSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6991 E CAMELBACK RD STE D300
SCOTTSDALE AZ
85251-2492
US

IV. Provider business mailing address

3366 E SIERRA MADRE AVE
GILBERT AZ
85296-1878
US

V. Phone/Fax

Practice location:
  • Phone: 623-429-1373
  • Fax:
Mailing address:
  • Phone: 480-309-2130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA11820
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: