MEDICARE: SHERRY M DICKIE M.S. CCC-A

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	231H00000X	Audiologist	21137	OR

General Provider Information

NPI Number	:	1578500880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRY M DICKIE M.S. CCC-A

Provider Business Mailing Address
First Line	:	PO BOX 742139
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90074-2139
Country	:	US
Telephone Number	:	503-553-3664
Fax Number	:	503-553-3668

Provider Business Practice Location Address
First Line	:	1849 NW KEARNEY ST
Second Line	:	STE 200
City	:	PORTLAND
State	:	OR
Zip	:	97209-1453
Country	:	US
Telephone Number	:	503-553-3664
Fax Number	:	503-553-3668

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	08/17/2018

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