Healthcare Provider Details

I. General information

NPI: 1295143113
Provider Name (Legal Business Name): JEANNINE DYKENS M.ED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 01/11/2025
Certification Date: 01/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 MELBOURNE ST APT 3
DORCHESTER MA
02124-2469
US

IV. Provider business mailing address

300 ONEIL BLVD APT 7
ATTLEBORO MA
02703-5124
US

V. Phone/Fax

Practice location:
  • Phone: 857-250-1028
  • Fax:
Mailing address:
  • Phone: 578-250-6775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: