Basic Information
| Provider Information | |||||||||
| NPI: | 1861407694 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DYMOND | ||||||||
| FirstName: | BARBARA | ||||||||
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| Credential: | M.S., CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2402 ROCKWOOD DR | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273308232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197770624 | ||||||||
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| Practice Location | |||||||||
| Address1: | 113 HILLCREST DR | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273304020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197770240 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 5013 | NC | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 7411641 | 05 | NC | MEDICAID |