Healthcare Provider Details

I. General information

NPI: 1740378207
Provider Name (Legal Business Name): ANN L. DYBVIK MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 HERITAGE DR
NORTHFIELD MN
55057-3152
US

IV. Provider business mailing address

1121 HERITAGE DR
NORTHFIELD MN
55057-3152
US

V. Phone/Fax

Practice location:
  • Phone: 507-645-1673
  • Fax:
Mailing address:
  • Phone: 507-645-1673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9256
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: