Provider Demographics
NPI:1699972349
Name:DICKERSON, JANET MARIE (LPCC, RN,)
Entity type:Individual
Prefix:MS
First Name:JANET
Middle Name:MARIE
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:LPCC, RN,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-1632
Mailing Address - Country:US
Mailing Address - Phone:419-448-4019
Mailing Address - Fax:
Practice Address - Street 1:24 W MARKET ST
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-2720
Practice Address - Country:US
Practice Address - Phone:419-448-4094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE. 0003629 SUPV101YP2500X
OHRN. 181935163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator