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General NPI Number Information
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NPI Number | 1366518946
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Entity Type | Individual
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Provider Name | ELIZABETH BENTLEY DICKARD M.A. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 430 W MAIN ST
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City | DOTHAN
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State | AL
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Zip | 36301-1616
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Country | US
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Telephone | 334-677-6955
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Fax |
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Provider Business Mailing Address
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Address Line | 126 VANN DR
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City | ASHFORD
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State | AL
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Zip | 36312-3406
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Country | US
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Telephone | 334-899-3612
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 1847
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License Number State | AL
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