Active NPI
Lisa Michelle Dymond, M.S. CCC-SLP
- Speech-Language Pathologist
- Churchville, MD
National Provider Identifier
1003479734
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 07609
- Practice address
- 124 Goucher Way
Churchville, MD 21028-1218 - Phone
- (410) 937-3338
- NPI assigned
- Apr 18, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 07609 | MD | Primary |
Addresses
Primary practice location
124 Goucher Way
Churchville, MD 21028-1218
Mailing address
1000 S Marlyn Ave
Baltimore, MD 21221-5999
Phone (410) 887-0112
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 07609 | MD | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1555545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1555545600000",
"number": "1003479734",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 S MARLYN AVE",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212215999",
"telephone_number": "410-887-0112"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "124 GOUCHER WAY",
"city": "CHURCHVILLE",
"state": "MD",
"postal_code": "210281218",
"telephone_number": "410-937-3338"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DYMOND",
"first_name": "LISA",
"middle_name": "MICHELLE",
"name_prefix": "Ms.",
"credential": "M.S. CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-04-18",
"last_updated": "2019-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MD",
"license": "07609",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Churchville, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.