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NPI Code Detail

MEDICARE: YLONDA DICKERSON

MEDICARE: YLONDA DICKERSON
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
1103K00000XBehavior Analyst1401212327NV

General Provider Information

NPI Number : 1477857514
Entity Type Code : Individual
Provider Name (Legal Business Name) : YLONDA DICKERSON
Provider Business Mailing Address
First Line : 2037 ENGLESTAD ST
Second Line :
City : N LAS VEGAS
State : NV
Zip : 89030-4026
Country : US
Telephone Number : 702-480-6421
Fax Number :
Provider Business Practice Location Address
First Line : 720 W CHEYENNE AVE STE 30
Second Line :
City : N LAS VEGAS
State : NV
Zip : 89030-7817
Country : US
Telephone Number : 702-487-5665
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2011
Last Update Date : 01/04/2011

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Directions to “ YLONDA DICKERSON ” Practice Location

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