Provider Demographics
NPI:1558121327
Name:DICKERSON, BONNIE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 US HIGHWAY 72 E STE E
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-4400
Mailing Address - Country:US
Mailing Address - Phone:256-464-9464
Mailing Address - Fax:256-325-9469
Practice Address - Street 1:1802 US HIGHWAY 72 E STE E
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-4400
Practice Address - Country:US
Practice Address - Phone:256-464-9464
Practice Address - Fax:256-325-9469
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14446648235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist