Healthcare Provider Details

I. General information

NPI: 1538006614
Provider Name (Legal Business Name): HEIDI JANEL DICKERSON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4117 MAIN ST
TIMNATH CO
80547-5011
US

IV. Provider business mailing address

1028 LARCH DR
WINDSOR CO
80550-4965
US

V. Phone/Fax

Practice location:
  • Phone: 970-227-7229
  • Fax:
Mailing address:
  • Phone: 970-227-7229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT.0021410
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: