Provider Demographics
NPI:1982179628
Name:BALCOME-DICKE, JEAN LEE
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:LEE
Last Name:BALCOME-DICKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 14TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-2590
Mailing Address - Country:US
Mailing Address - Phone:651-380-1482
Mailing Address - Fax:
Practice Address - Street 1:1001 14TH ST NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-2590
Practice Address - Country:US
Practice Address - Phone:507-534-2668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health