Provider Demographics
NPI:1336456359
Name:DICKMAN, MANDI ALLISON (MSCCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MANDI
Middle Name:ALLISON
Last Name:DICKMAN
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 W SAUGERTIES RD
Mailing Address - Street 2:
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477-3142
Mailing Address - Country:US
Mailing Address - Phone:845-247-8777
Mailing Address - Fax:845-247-8780
Practice Address - Street 1:48 BIRCHES LN
Practice Address - Street 2:
Practice Address - City:ELLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12428-8127
Practice Address - Country:US
Practice Address - Phone:845-647-2557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012032-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist