Provider Demographics
NPI:1083097307
Name:DICKINSON, JENNIFER LEAH (SLPA)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LEAH
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 REGAL DR
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-1836
Mailing Address - Country:US
Mailing Address - Phone:815-901-8401
Mailing Address - Fax:
Practice Address - Street 1:400 REGAL DR
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-1836
Practice Address - Country:US
Practice Address - Phone:815-901-8401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-06
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant