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General NPI Number Information
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NPI Number | 1144721291
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Entity Type | Individual
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Provider Name | DENISE DYSERT CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 02/23/2018
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Last Update Date | 02/23/2018
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Provider Practice Location Address
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Address Line | 11201 PINEWOOD CT
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City | HENRICO
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State | VA
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Zip | 23238-5314
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Country | US
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Telephone | 804-741-4712
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Fax |
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Provider Business Mailing Address
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Address Line | 11201 PINEWOOD CT
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City | HENRICO
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State | VA
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Zip | 23238-5314
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Country | US
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Telephone | 804-741-4712
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2202000804
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License Number State | VA
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