Dominique Dickerson, M.A. CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

22008321A Issued in IN

Practice address

9957 Allisonville Rd
Fishers, IN 46038-2006

Phone

(317) 841-7005

NPI assigned

Mar 9, 2023

Last updated

Mar 9, 2023By 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

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.

• Theracare Inc

  dba Footprints Pediatric Inc

  • Rehabilitation Clinic/Center
  • Osceola, IN
  • NPI 1811165269

  Speech-Language Pathologist

  NPD
• Theracare Inc.

  dba Tots

  • Rehabilitation Clinic/Center
  • Fishers, IN
  • NPI 1023052339

  Speech-Language Pathologist

  NPD

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

{
    "created_epoch": "1678320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678320000000",
    "number": "1922708619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5960 ALLISONVILLE RD",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462205202",
            "telephone_number": "812-677-8891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9957 ALLISONVILLE RD",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "460382006",
            "telephone_number": "317-841-7005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "DOMINIQUE",
        "credential": "M.A. CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-09",
        "last_updated": "2023-03-09",
        "certification_date": "2023-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IN",
            "license": "22008321A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dettwiler Chiropractic, L.L.C.
• Jeffrey Daniel Dettwiler, D.C.
• Weston Devore
• Luanne Devries, MA, CCC-SLP
• Stephen Paul Dewey, MD
• Erin M Dickerson, LCSW
• Michael L Didonna, MD
• Dietary Solutions of Indiana, PC
• Pam Dietz, CPNP
• Lisa Jo Dillman, RN

• Speech-Language Pathologist in Fishers, IN
• Providers in Fishers, 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 Mar 9, 2023; 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.