Provider Demographics
NPI:1710606793
Name:DICKMAN, MAUREEN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:DICKMAN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 SHORT ST
Mailing Address - Street 2:
Mailing Address - City:RANTOUL
Mailing Address - State:IL
Mailing Address - Zip Code:61866-3335
Mailing Address - Country:US
Mailing Address - Phone:217-893-4141
Mailing Address - Fax:
Practice Address - Street 1:1625 SHORT ST
Practice Address - Street 2:
Practice Address - City:RANTOUL
Practice Address - State:IL
Practice Address - Zip Code:61866-3335
Practice Address - Country:US
Practice Address - Phone:217-893-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146016438235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty