Healthcare Provider Details

I. General information

NPI: 1518625227
Provider Name (Legal Business Name): ERICA ROCHELLE DICKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2021
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7840 E SOUTHERN DR
COLUMBIA MO
65201-7026
US

IV. Provider business mailing address

7840 E SOUTHERN DR
COLUMBIA MO
65201-7026
US

V. Phone/Fax

Practice location:
  • Phone: 573-424-5485
  • Fax:
Mailing address:
  • Phone: 573-424-5485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: