MEDICARE: RONALD DICKER INC.

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	103T00000X	Psychologist	01098	MO

General Provider Information

NPI Number	:	1083827422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RONALD DICKER INC.

Provider Business Mailing Address
First Line	:	9374 OLIVE BLVD
Second Line	:	SUITE 103
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-3253
Country	:	US
Telephone Number	:	636-578-9805
Fax Number	:	314-997-7824

Provider Business Practice Location Address
First Line	:	9374 OLIVE BLVD
Second Line	:	SUITE 103
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-3253
Country	:	US
Telephone Number	:	636-578-9805
Fax Number	:	314-997-7824

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	RONALD B DICKER
Credential	:	PH.D.
Telephone Number	:	636-578-9805

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	08/22/2020

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Directions to “RONALD DICKER INC. ” Practice Location

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