Healthcare Provider Details

I. General information

NPI: 1922914514
Provider Name (Legal Business Name): SEAN A. DICKMAN EMT, QBHA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5435 W JEWELL AVE
LAKEWOOD CO
80232-7205
US

IV. Provider business mailing address

5435 W JEWELL AVE
LAKEWOOD CO
80232-7205
US

V. Phone/Fax

Practice location:
  • Phone: 970-628-6766
  • Fax:
Mailing address:
  • Phone: 970-628-6766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: