Provider Demographics
NPI:1093088437
Name:STACKHOUSE DICKERSON, DAWN (MED, IBCLC, RLC, CD)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:STACKHOUSE DICKERSON
Suffix:
Gender:F
Credentials:MED, IBCLC, RLC, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11137 CAMINITO INOCENTA
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-6109
Mailing Address - Country:US
Mailing Address - Phone:858-218-6455
Mailing Address - Fax:
Practice Address - Street 1:11137 CAMINITO INOCENTA
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-6109
Practice Address - Country:US
Practice Address - Phone:858-218-6455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No174H00000XOther Service ProvidersHealth Educator