Provider Demographics
NPI:1699047126
Name:DICKERSON, LINDA L (SLP)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:L
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 S COUNTY ROAD 90 W
Mailing Address - Street 2:
Mailing Address - City:NORTH VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47265-8385
Mailing Address - Country:US
Mailing Address - Phone:812-346-7852
Mailing Address - Fax:
Practice Address - Street 1:380 S COUNTY ROAD 90 W
Practice Address - Street 2:
Practice Address - City:NORTH VERNON
Practice Address - State:IN
Practice Address - Zip Code:47265-8385
Practice Address - Country:US
Practice Address - Phone:812-346-7852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN385758235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist