Doctor Name: | DR. TRACIE BULLOCK DICKSON |
NPI Number: | 1063738300 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 06177 |
Business Practice Address: | 1307 Quincy St Ne Washington, DC - 200172615 |
Business Phone Number: | 2026361685 |
Business Fax Number: | |
Mailing Address: | 1307 Quincy St Ne, WASHINGTON |
State: | DC |
Postal Code: | 200172615 |
Phone Number: | 2026361685 |
Fax Number: | |
NPI Enumeration Date: | 04/12/2010 |
NPI Last Update Date: | 04/12/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 06177 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |