Provider Demographics
NPI:1407590235
Name:DICKSON, JILL LAUREN (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:LAUREN
Last Name:DICKSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 BASLIA LN
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-6124
Mailing Address - Country:US
Mailing Address - Phone:908-410-2535
Mailing Address - Fax:
Practice Address - Street 1:9045 CHURCH ST E
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5841
Practice Address - Country:US
Practice Address - Phone:615-431-1920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP0000007644235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist