Provider Demographics
NPI:1134663560
Name:DICKERSON, REED MASER (BA,)
Entity Type:Individual
Prefix:MR
First Name:REED
Middle Name:MASER
Last Name:DICKERSON
Suffix:
Gender:M
Credentials:BA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 N PINE GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-4552
Mailing Address - Country:US
Mailing Address - Phone:307-421-0397
Mailing Address - Fax:
Practice Address - Street 1:2025 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-5131
Practice Address - Country:US
Practice Address - Phone:847-360-1020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-04
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional