Provider Demographics
NPI:1801038880
Name:DICKERSON, SUE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUE
Middle Name:
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1052 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-4558
Mailing Address - Country:US
Mailing Address - Phone:254-965-3611
Mailing Address - Fax:254-965-3618
Practice Address - Street 1:1052 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-4558
Practice Address - Country:US
Practice Address - Phone:254-965-3611
Practice Address - Fax:254-965-3618
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17935235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist