Provider Demographics
NPI:1639408669
Name:DICKMAN, MALIA (MS)
Entity Type:Individual
Prefix:
First Name:MALIA
Middle Name:
Last Name:DICKMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:FALL CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:54742-9397
Mailing Address - Country:US
Mailing Address - Phone:715-877-1618
Mailing Address - Fax:715-877-1614
Practice Address - Street 1:344 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:FALL CREEK
Practice Address - State:WI
Practice Address - Zip Code:54742-9397
Practice Address - Country:US
Practice Address - Phone:715-877-1618
Practice Address - Fax:715-877-1614
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3296235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist