Provider Demographics
NPI:1861864811
Name:DICKEN, AIDA ARACELI
Entity Type:Individual
Prefix:MRS
First Name:AIDA
Middle Name:ARACELI
Last Name:DICKEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHELY
Other - Middle Name:
Other - Last Name:DICKEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:230 W ORLEANS AVE
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-7032
Mailing Address - Country:US
Mailing Address - Phone:623-302-8445
Mailing Address - Fax:
Practice Address - Street 1:230 W ORLEANS AVE
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-7032
Practice Address - Country:US
Practice Address - Phone:623-302-8445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator