Healthcare Provider Details

I. General information

NPI: 1326956103
Provider Name (Legal Business Name): JULIE A DICKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 N YORK ST STE H
MUSKOGEE OK
74403-1442
US

IV. Provider business mailing address

17056 E CLOVER CIR
TAHLEQUAH OK
74464-0595
US

V. Phone/Fax

Practice location:
  • Phone: 918-912-2796
  • Fax:
Mailing address:
  • Phone: 918-822-1198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA465
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: