Provider Demographics
NPI:1053827006
Name:DICKENSON, SELINA
Entity Type:Individual
Prefix:
First Name:SELINA
Middle Name:
Last Name:DICKENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 FLORENCE DR
Mailing Address - Street 2:
Mailing Address - City:MACEDONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44056-1111
Mailing Address - Country:US
Mailing Address - Phone:330-255-9144
Mailing Address - Fax:
Practice Address - Street 1:1031 FLORENCE DR
Practice Address - Street 2:
Practice Address - City:MACEDONIA
Practice Address - State:OH
Practice Address - Zip Code:44056-1111
Practice Address - Country:US
Practice Address - Phone:330-255-9144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-28
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No171M00000XOther Service ProvidersCase Manager/Care Coordinator