Provider Demographics
NPI:1013386325
Name:DICKERSON, LORI (MSCE, JD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:MSCE, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 PALM SPRINGS AVE
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-6105
Mailing Address - Country:US
Mailing Address - Phone:307-637-2846
Mailing Address - Fax:
Practice Address - Street 1:207 PALM SPRINGS AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-6105
Practice Address - Country:US
Practice Address - Phone:307-637-2846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator