Provider Demographics
NPI:1912241282
Name:DICKEY, ESOSA NICHOLE (SLP)
Entity type:Individual
Prefix:MS
First Name:ESOSA
Middle Name:NICHOLE
Last Name:DICKEY
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 1:411 MEREDITH ST
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27260-5534
Mailing Address - Country:US
Mailing Address - Phone:336-883-6532
Mailing Address - Fax:
Practice Address - Street 1:411 MEREDITH ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27260-5534
Practice Address - Country:US
Practice Address - Phone:336-883-6532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6659235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist