Jacki S Dickinson, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

17685 Issued in OR

Practice address

3514 NE 57TH Ave
Portland, OR 97213-1737

Phone

(503) 680-1534

NPI assigned

Apr 26, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Jacqueline Spathas-Dickinson Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1303776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303776000000",
    "number": "1376834267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3514 NE 57TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97213",
            "telephone_number": "503-680-1534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3514 NE 57TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972131737",
            "telephone_number": "503-680-1534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKINSON",
        "first_name": "JACKI",
        "middle_name": "S",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-04-26",
        "last_updated": "2011-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "OR",
            "license": "17685",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "SPATHAS-DICKINSON",
            "credential": "LMT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Markus Dickerson
• Sharayah Dickerson
• Sherry M Dickie, M.S. CCC-A
• Valerie Dickie, CADC-R
• Ian Robert Dickinson, DMD
• Lisa Anne Dickinson, ND
• Shadey Dickinson
• Emily Marie Dickman
• Alfred Dickson, M.D.
• Courtney Dickson, DPT

• Massage Therapist in Portland, OR
• Providers in Portland, OR by specialty
• Massage Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2011; 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.