Provider Demographics
NPI:1518193135
Name:DICKINSON, LISA MICHELLE (MA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELLE
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 BREAKER CIR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-1803
Mailing Address - Country:US
Mailing Address - Phone:615-812-4356
Mailing Address - Fax:
Practice Address - Street 1:103 BREAKER CIR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-1803
Practice Address - Country:US
Practice Address - Phone:615-812-4356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000003442235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist