Healthcare Provider Details

I. General information

NPI: 1215861760
Provider Name (Legal Business Name): ALLISON VAN DYKE MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3244 51ST ST S
FARGO ND
58104-7179
US

IV. Provider business mailing address

3244 51ST ST S
FARGO ND
58104-7179
US

V. Phone/Fax

Practice location:
  • Phone: 701-356-0062
  • Fax:
Mailing address:
  • Phone: 701-356-0062
  • Fax: 701-356-5412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3124
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: