Provider Demographics
NPI:1386630762
Name:DICKHAUT, ANDREW R (SLP)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:R
Last Name:DICKHAUT
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 S CLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-2129
Mailing Address - Country:US
Mailing Address - Phone:605-334-5630
Mailing Address - Fax:605-332-5327
Practice Address - Street 1:1720 S CLIFF AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-2129
Practice Address - Country:US
Practice Address - Phone:605-334-5630
Practice Address - Fax:605-332-5327
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01409235Z00000X
MN7574235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN46-00669OtherMEDICA
MN066L0DIOtherBLUE CROSS BLUE SHIELD MN
MN46-00668OtherMEDICA
MN46-00667OtherMEDICA
MN1783426OtherARAZ
MN46-00864OtherMEDICA
MN28975OtherSIOUX VALLEY HEALTH PLANS
MN7736OtherAVERA HEALTH PLANS
MN46-00762OtherMEDICA