Basic Information
| Provider Information | |||||||||
| NPI: | 1861640633 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUDEK | ||||||||
| FirstName: | LYNN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MS,CCC-SLP, BCBA,MBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4415 SWENSON ST | ||||||||
| Address2: | |||||||||
| City: | HILLIARD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430263805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145290672 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2540 BILLINGSLEY RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432351990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144702018 | ||||||||
| FaxNumber: | 6144896200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2008 | ||||||||
| LastUpdateDate: | 01/14/2019 | ||||||||
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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 | SP 4345 | OH | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 0261124 | 05 | OH | MEDICAID |