Provider Demographics
NPI:1083827422
Name:RONALD DICKER INC.
Entity Type:Organization
Organization Name:RONALD DICKER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:B
Authorized Official - Last Name:DICKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:636-578-9805
Mailing Address - Street 1:9374 OLIVE BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-3253
Mailing Address - Country:US
Mailing Address - Phone:636-578-9805
Mailing Address - Fax:314-997-7824
Practice Address - Street 1:9374 OLIVE BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-3253
Practice Address - Country:US
Practice Address - Phone:636-578-9805
Practice Address - Fax:314-997-7824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01098103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty