Provider Demographics
NPI:1063064236
Name:DICKSON, KELLILYNN MARIE
Entity type:Individual
Prefix:
First Name:KELLILYNN
Middle Name:MARIE
Last Name:DICKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KELLILYNN
Other - Middle Name:MARIE
Other - Last Name:ALLEGRETTI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4950 W 23RD ST STE 1
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-5802
Mailing Address - Country:US
Mailing Address - Phone:814-459-2755
Mailing Address - Fax:814-456-4873
Practice Address - Street 1:4950 W 23RD ST STE 1
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-5802
Practice Address - Country:US
Practice Address - Phone:814-459-2755
Practice Address - Fax:814-456-4873
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst