Provider Demographics
NPI:1265309199
Name:DICKINSON, GRACE MARIE (MS CFY-SLP)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:MARIE
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:MS CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 DONNELL RIDGE RD APT 1209
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-8786
Mailing Address - Country:US
Mailing Address - Phone:479-970-9972
Mailing Address - Fax:
Practice Address - Street 1:11520 SR 27
Practice Address - Street 2:
Practice Address - City:HECTOR
Practice Address - State:AR
Practice Address - Zip Code:72843-8710
Practice Address - Country:US
Practice Address - Phone:479-284-2021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-23
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist