Nadiyah Dickerson

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

22006354A Issued in IN

Practice address

1595 S Calumet Rd Ste 3
Chesterton, IN 46304-2389

Phone

(219) 764-4888

Fax

(219) 898-4258

NPI assigned

Jul 22, 2008

Last updated

Jun 14, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jacob's Ladder Pediatric Rehab Center

  • Speech-Language Pathologist
  • Chesterton, IN
  • NPI 1164251849
  NPD (past)
• Jacob's Ladder Pediatric Rehab Center

  • Physical Therapist
  • Chesterton, IN
  • NPI 1265519151

  Speech-Language Pathologist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1216684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560470400000",
    "number": "1326203076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1595 S CALUMET RD STE 3",
            "city": "CHESTERTON",
            "state": "IN",
            "postal_code": "463042389",
            "telephone_number": "219-764-4888",
            "fax_number": "219-898-4258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1595 S CALUMET RD STE 3",
            "city": "CHESTERTON",
            "state": "IN",
            "postal_code": "463042389",
            "telephone_number": "219-764-4888",
            "fax_number": "219-898-4258"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1049 E Wilson St",
            "address_purpose": "LOCATION",
            "city": "Batavia",
            "state": "IL",
            "postal_code": "605102474",
            "country_code": "US",
            "telephone_number": "630-761-0900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "NADIYAH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-22",
        "last_updated": "2019-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "242000410",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IN",
            "license": "22006354A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200196020A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Chesterton, IN
• Providers in Chesterton, IN by specialty
• Speech-Language Pathologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.