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General NPI Number Information
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NPI Number | 1316614449
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Entity Type | Individual
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Provider Name | JULIE SIPPEL DICKINSON MCD, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/26/2021
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Last Update Date | 08/26/2021
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Provider Practice Location Address
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Address Line | 9075 KINGSTON RD
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City | SHREVEPORT
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State | LA
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Zip | 71118-3415
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Country | US
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Telephone | 318-686-1974
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Fax | 318-688-4459
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Provider Business Mailing Address
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Address Line | 1170 ONTARIO ST
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City | SHREVEPORT
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State | LA
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Zip | 71106-1414
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Country | US
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Telephone | 318-465-1276
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 4406
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License Number State | LA
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