MEDICARE: JOHN D DICK MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	3283	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3283	OTHER	MN	LICSW

General Provider Information

NPI Number	:	1073716023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN D DICK MSW

Provider Business Mailing Address
First Line	:	11307 TOWERING PINES CT
Second Line	:
City	:	BEMIDJI
State	:	MN
Zip	:	56601
Country	:	US
Telephone Number	:	218-679-3912
Fax Number	:	218-679-0181

Provider Business Practice Location Address
First Line	:	HWY 1
Second Line	:
City	:	REDLAKE
State	:	MN
Zip	:	56671-0497
Country	:	US
Telephone Number	:	218-679-3912
Fax Number	:	218-679-0181

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	07/08/2007

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Directions to “ JOHN D DICK MSW” Practice Location

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