Provider Demographics
NPI:1285108456
Name:DZIBINSKI, DESTINY
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:
Last Name:DZIBINSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 S 122ND LN
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-8425
Mailing Address - Country:US
Mailing Address - Phone:602-369-6108
Mailing Address - Fax:
Practice Address - Street 1:623 S 122ND LN
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-8425
Practice Address - Country:US
Practice Address - Phone:602-369-6108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-21
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant