Provider Demographics
NPI:1497471536
Name:DICKSON, KENDREA (MSW)
Entity Type:Individual
Prefix:
First Name:KENDREA
Middle Name:
Last Name:DICKSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6707 NOBLE LN N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-1605
Mailing Address - Country:US
Mailing Address - Phone:612-401-6125
Mailing Address - Fax:
Practice Address - Street 1:6707 NOBLE LN N
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-1605
Practice Address - Country:US
Practice Address - Phone:612-401-6125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical