Provider Demographics
NPI:1588864128
Name:VAN DYKE, SHARON (SLP)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:VAN DYKE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:959 MERRIMON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-2466
Mailing Address - Country:US
Mailing Address - Phone:828-417-7085
Mailing Address - Fax:828-417-7059
Practice Address - Street 1:959 MERRIMON AVE STE 101
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-2466
Practice Address - Country:US
Practice Address - Phone:828-273-4852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2023-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5744235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC14313OtherBCBS PIN