Provider Demographics
NPI:1649505819
Name:DICKERSON, JENNIFER (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
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 1:1140 W MAIN ST
Mailing Address - Street 2:ATTN: REHABCARE
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-4222
Mailing Address - Country:US
Mailing Address - Phone:540-381-1742
Mailing Address - Fax:540-381-1742
Practice Address - Street 1:1140 W MAIN ST
Practice Address - Street 2:ATTN: REHABCARE
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-4222
Practice Address - Country:US
Practice Address - Phone:540-381-1742
Practice Address - Fax:540-381-1742
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004522235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist