Provider Demographics
NPI:1578500880
Name:DICKIE, SHERRY M (MS CCC-A)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:M
Last Name:DICKIE
Suffix:
Gender:F
Credentials:MS CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 742139
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-2139
Mailing Address - Country:US
Mailing Address - Phone:503-553-3664
Mailing Address - Fax:503-553-3668
Practice Address - Street 1:1849 NW KEARNEY ST
Practice Address - Street 2:STE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1453
Practice Address - Country:US
Practice Address - Phone:503-553-3664
Practice Address - Fax:503-553-3668
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21137231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist