Provider Demographics
NPI:1417391806
Name:DICKS, WENDY RENEE (BA)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:RENEE
Last Name:DICKS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3970 DEWEY COX RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:SC
Mailing Address - Zip Code:29560-7798
Mailing Address - Country:US
Mailing Address - Phone:843-372-8960
Mailing Address - Fax:
Practice Address - Street 1:3970 DEWEY COX RD
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:SC
Practice Address - Zip Code:29560-7798
Practice Address - Country:US
Practice Address - Phone:843-372-8960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist