Provider Demographics
NPI:1144946153
Name:DICKERSON, KATHERINE ANNE (SOCIAL WORKER)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANNE
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 LANDER ST APT B
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-2027
Mailing Address - Country:US
Mailing Address - Phone:775-447-0062
Mailing Address - Fax:
Practice Address - Street 1:1575 DELUCCHI LN STE 225
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-6582
Practice Address - Country:US
Practice Address - Phone:775-437-5272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-12
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVIC-23471041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker