Provider Demographics
NPI:1144655580
Name:DYSON, ELIZABETH NICOLE (BSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:NICOLE
Last Name:DYSON
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3563 S STATE ROAD 13
Mailing Address - Street 2:
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992-9162
Mailing Address - Country:US
Mailing Address - Phone:260-563-8453
Mailing Address - Fax:260-569-0335
Practice Address - Street 1:3563 S STATE ROAD 13
Practice Address - Street 2:
Practice Address - City:WABASH
Practice Address - State:IN
Practice Address - Zip Code:46992-9162
Practice Address - Country:US
Practice Address - Phone:260-563-8453
Practice Address - Fax:260-569-0335
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker