Provider Demographics
NPI:1588863682
Name:ALLES, CATHERINE DYKSTRA (MA, CCC/A, F/AAA)
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:DYKSTRA
Last Name:ALLES
Suffix:
Gender:F
Credentials:MA, CCC/A, F/AAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2187 TIMOTHY DR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-7728
Mailing Address - Country:US
Mailing Address - Phone:410-635-6348
Mailing Address - Fax:410-876-4905
Practice Address - Street 1:290 S CENTER ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5219
Practice Address - Country:US
Practice Address - Phone:410-876-4449
Practice Address - Fax:410-876-4905
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD216231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD214293700Medicaid