Provider Demographics
NPI:1114113651
Name:DICKSON, AMY HULL (MHA, MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:HULL
Last Name:DICKSON
Suffix:
Gender:F
Credentials:MHA, MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 FOLLY RD
Mailing Address - Street 2:SUITE P-152
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-3019
Mailing Address - Country:US
Mailing Address - Phone:843-478-7918
Mailing Address - Fax:
Practice Address - Street 1:520 FOLLY RD
Practice Address - Street 2:SUITE P-152
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-3019
Practice Address - Country:US
Practice Address - Phone:843-478-7918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3138235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist