Provider Demographics
NPI:1689025652
Name:HEWETT, DORI FAULK
Entity type:Individual
Prefix:
First Name:DORI
Middle Name:FAULK
Last Name:HEWETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DORI
Other - Middle Name:LANE
Other - Last Name:FAULK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1005 BAY RD SW
Mailing Address - Street 2:
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28470-5341
Mailing Address - Country:US
Mailing Address - Phone:910-505-8544
Mailing Address - Fax:910-518-8688
Practice Address - Street 1:1005 BAY RD SW
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-5341
Practice Address - Country:US
Practice Address - Phone:910-505-8544
Practice Address - Fax:910-518-8688
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11872235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist