Healthcare Provider Details

I. General information

NPI: 1053475111
Provider Name (Legal Business Name): DALE DICKER MED LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11715 ADMINISTRATION DR STE 101
ST LOUIS MO
63146
US

IV. Provider business mailing address

11715 ADMINISTRATION DR STE 101
ST LOUIS MO
63146
US

V. Phone/Fax

Practice location:
  • Phone: 314-993-8123
  • Fax: 314-993-8123
Mailing address:
  • Phone: 314-993-8123
  • Fax: 314-993-8123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number000956
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number002320
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: