Provider Demographics
NPI:1932486875
Name:DICKENSON, PAJA LE (MA CCC -A)
Entity Type:Individual
Prefix:
First Name:PAJA
Middle Name:LE
Last Name:DICKENSON
Suffix:
Gender:F
Credentials:MA CCC -A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3566 CAPITAL AVE SW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-7387
Mailing Address - Country:US
Mailing Address - Phone:269-979-6455
Mailing Address - Fax:269-979-6458
Practice Address - Street 1:3566 CAPITAL AVE SW
Practice Address - Street 2:SUITE 100
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-7387
Practice Address - Country:US
Practice Address - Phone:269-979-6455
Practice Address - Fax:269-979-6458
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000043231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist