Provider Demographics
NPI:1386978310
Name:DICKEN, ADRIENNE TYLER (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:TYLER
Last Name:DICKEN
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 1:4468 HARTLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-1516
Mailing Address - Country:US
Mailing Address - Phone:859-492-3102
Mailing Address - Fax:866-938-2180
Practice Address - Street 1:175 W LOWRY LN
Practice Address - Street 2:SUITE 104
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3012
Practice Address - Country:US
Practice Address - Phone:859-475-4305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3763235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist