Provider Demographics
NPI:1871009506
Name:DICKSON, DEIRDRE ELAINE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DEIRDRE
Middle Name:ELAINE
Last Name:DICKSON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MS
Other - First Name:DEIRDRE
Other - Middle Name:ELAINE
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:791 MIDLINE RD.
Mailing Address - Street 2:
Mailing Address - City:FREEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13068-5620
Mailing Address - Country:US
Mailing Address - Phone:607-279-1441
Mailing Address - Fax:
Practice Address - Street 1:8842 STATE ROUTE 90 N
Practice Address - Street 2:
Practice Address - City:KING FERRY
Practice Address - State:NY
Practice Address - Zip Code:13081-8717
Practice Address - Country:US
Practice Address - Phone:315-364-7570
Practice Address - Fax:315-364-7570
Is Sole Proprietor?:No
Enumeration Date:2017-12-18
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist