Provider Demographics
NPI:1154161065
Name:DICKSON, ANN K (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:K
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 1:4017 DON CIR
Mailing Address - Street 2:
Mailing Address - City:NEW FRANKEN
Mailing Address - State:WI
Mailing Address - Zip Code:54229-9473
Mailing Address - Country:US
Mailing Address - Phone:920-646-0800
Mailing Address - Fax:
Practice Address - Street 1:4017 DON CIR
Practice Address - Street 2:
Practice Address - City:NEW FRANKEN
Practice Address - State:WI
Practice Address - Zip Code:54229-9473
Practice Address - Country:US
Practice Address - Phone:920-646-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1630235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist