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NPI Code Detail

MEDICARE: DOMINIQUE DICKESON

MEDICARE: DOMINIQUE DICKESON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianBACB535178IL

General Provider Information

NPI Number : 1275270670
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOMINIQUE DICKESON
Provider Business Mailing Address
First Line : 814 COMMERCE DR STE 100
Second Line :
City : OAK BROOK
State : IL
Zip : 60523-8822
Country : US
Telephone Number : 630-526-4170
Fax Number :
Provider Business Practice Location Address
First Line : 814 COMMERCE DR STE 100
Second Line :
City : OAK BROOK
State : IL
Zip : 60523-8822
Country : US
Telephone Number : 630-526-4170
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2022
Last Update Date : 05/17/2022

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Directions to “ DOMINIQUE DICKESON ” Practice Location

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