Provider Demographics
NPI:1821316225
Name:DICKMAN, BRENDA M (AUD)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:M
Last Name:DICKMAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:FORT JENNINGS
Mailing Address - State:OH
Mailing Address - Zip Code:45844-0092
Mailing Address - Country:US
Mailing Address - Phone:919-519-0105
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 92
Practice Address - Street 2:
Practice Address - City:FORT JENNINGS
Practice Address - State:OH
Practice Address - Zip Code:45844-0092
Practice Address - Country:US
Practice Address - Phone:919-519-0105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001425231H00000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1821316225Medicaid
NCP01653259OtherMEDICARE RAILROAD
SCSAN127Medicaid
NCQ49209BOtherMEDICARE