Physician Compare National (NPI:1053409722)

HEALTHCARE PROVIDER: LATREECE EVETTE DICKERSON PSY.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1053409722
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0042445769
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20180531002948
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DICKERSON
	Individual professional last name
Provider First Name	LATREECE
	Individual professional first name
Provider Middle Name	E
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	LOYOLA UNIVERSITY OF CHICAGO, STRITCH SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1996
	Individual professional's medical school graduation year
Primary Specialty	PSYCHOLOGIST, CLINICAL
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	8941 S WESTERN AVE
	Group Practice or individual's line 1 address
City	CHICAGO
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	606436432
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y