Provider Demographics
NPI:1528801271
Name:DICKERSON, CAROL G (SLP)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:G
Last Name:DICKERSON
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 1:318 KENDALL AVE
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-2854
Mailing Address - Country:US
Mailing Address - Phone:601-600-2633
Mailing Address - Fax:601-385-1626
Practice Address - Street 1:318 KENDALL AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2854
Practice Address - Country:US
Practice Address - Phone:601-600-2633
Practice Address - Fax:601-385-1626
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS-2126235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist