Provider Demographics
NPI:1841673910
Name:DICKSON, JENNIFER CRANE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CRANE
Last Name:DICKSON
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 1:4410 SMITH POND RD
Mailing Address - Street 2:
Mailing Address - City:AVOCA
Mailing Address - State:NY
Mailing Address - Zip Code:14809-9583
Mailing Address - Country:US
Mailing Address - Phone:315-404-5457
Mailing Address - Fax:
Practice Address - Street 1:4410 SMITH POND RD
Practice Address - Street 2:
Practice Address - City:AVOCA
Practice Address - State:NY
Practice Address - Zip Code:14809-9583
Practice Address - Country:US
Practice Address - Phone:315-404-5457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024765-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist