Healthcare Provider Details

I. General information

NPI: 1265309199
Provider Name (Legal Business Name): GRACE MARIE DICKINSON MS CFY-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 10/24/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11520 SR 27
HECTOR AR
72843-8710
US

IV. Provider business mailing address

3815 DONNELL RIDGE RD APT 1209
CONWAY AR
72034-8786
US

V. Phone/Fax

Practice location:
  • Phone: 479-284-2021
  • Fax:
Mailing address:
  • Phone: 479-970-9972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: