MEDICARE: DEBBIE ELAINE DICKSON LISW

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	1041C0700X	Clinical Social Worker	IOOO5776	OH

General Provider Information

NPI Number	:	1982718128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBBIE ELAINE DICKSON LISW

Provider Business Mailing Address
First Line	:	41191 TR 78
Second Line	:
City	:	COSHOCTON
State	:	OH
Zip	:	43812
Country	:	US
Telephone Number	:	740-587-2822
Fax Number	:	740-587-2822

Provider Business Practice Location Address
First Line	:	905 RIVER RD STE A
Second Line	:
City	:	GRANVILLE
State	:	OH
Zip	:	43023-9560
Country	:	US
Telephone Number	:	740-587-2822
Fax Number	:	740-587-2822

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

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	07/08/2007

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