Provider Demographics
NPI:1801906631
Name:DICKSON, STACY (AUD CCC A)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:DICKSON
Suffix:
Gender:F
Credentials:AUD CCC A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 STURTEVANT ST # MP304
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2022
Mailing Address - Country:US
Mailing Address - Phone:321-841-1681
Mailing Address - Fax:321-841-6144
Practice Address - Street 1:50 STURTEVANT ST # MP304
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2022
Practice Address - Country:US
Practice Address - Phone:321-841-6144
Practice Address - Fax:407-649-8869
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1238231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist