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NPI Code Detail

MEDICARE: MRS. SHANNON T DICKERSON LMFT

MEDICARE: MRS. SHANNON T DICKERSON LMFT
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
1106H00000XMarriage & Family TherapistLF60093186WA

General Provider Information

NPI Number : 1376695619
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHANNON T DICKERSON LMFT
Provider Business Mailing Address
First Line : 7805 11TH ST NE
Second Line :
City : LAKE STEVENS
State : WA
Zip : 98258-3449
Country : US
Telephone Number : 206-734-1676
Fax Number : 360-698-9296
Provider Business Practice Location Address
First Line : 135 N OLYMPIC AVE
Second Line :
City : ARLINGTON
State : WA
Zip : 98223-1335
Country : US
Telephone Number : 360-474-6262
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2007
Last Update Date : 01/22/2020

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