Provider Demographics
NPI:1699292623
Name:DICKS, REBEKKA JEAN (MS-SLP)
Entity type:Individual
Prefix:
First Name:REBEKKA
Middle Name:JEAN
Last Name:DICKS
Suffix:
Gender:F
Credentials:MS-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2848 PARKER ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3397
Mailing Address - Country:US
Mailing Address - Phone:313-768-5669
Mailing Address - Fax:
Practice Address - Street 1:2848 PARKER ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3397
Practice Address - Country:US
Practice Address - Phone:313-768-5669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101005465235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist