MEDICARE: MS. ROSETTA L DICKEY CPRS

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	175T00000X	Peer Specialist	APS.006069	OH
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1386442937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROSETTA L DICKEY CPRS

Provider Business Mailing Address
First Line	:	3965 PARLIAMENT PL APT 96
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45429-4334
Country	:	US
Telephone Number	:	937-510-8310
Fax Number	:

Provider Business Practice Location Address
First Line	:	3965 PARLIAMENT PL APT 96
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45429-4334
Country	:	US
Telephone Number	:	937-510-8310
Fax Number	:

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

Provider Enumeration Date	:	03/07/2025
Last Update Date	:	03/06/2026

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