MEDICARE: MRS. BECKY JO DYER M.A. CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP 2999	OH

General Provider Information

NPI Number	:	1073916060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BECKY JO DYER M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	2645 SMITH RD
Second Line	:
City	:	FAIRLAWN
State	:	OH
Zip	:	44333-2805
Country	:	US
Telephone Number	:	330-664-4991
Fax Number	:

Provider Business Practice Location Address
First Line	:	2645 SMITH RD
Second Line	:
City	:	FAIRLAWN
State	:	OH
Zip	:	44333-2805
Country	:	US
Telephone Number	:	330-664-4991
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2014
Last Update Date	:	10/03/2014

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Directions to “ MRS. BECKY JO DYER M.A. CCC-SLP” Practice Location

Language	Start Address	Practice Location

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