Dickerson, Joan P

Dickerson, Joan P is an sole proprietor health care provider with primary practice located at 3333 N Mayfair Rd Suite 210, Wauwatosa WI 53222-3219. She recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Professional, Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Marriage & Family Therapist. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Dickerson, Joan P can be contacted via phone (414) 750-8033.

Contact Information

Primary practice address
3333 N Mayfair Rd Suite 210 Wauwatosa WI 53222-3219
Phone: (414) 750-8033
Fax: (414) 778-1531
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X 340-125 Wisconsin
Behavioral Health & Social Service Providers / Clinical 1041C0700X 1178-123 Wisconsin
Behavioral Health & Social Service Providers / Marriage & Family Therapist 106H00000X 391-124 Wisconsin

Profile Details

NPI number 1487661757
LBN Legal business name Dickerson, Joan P
Credentials M.S.,LCSW, LMFT, LPC
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 1st, 2006
Last updated Nov 4th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487661757 NPPES
Wisconsin MEDICAID 40918800

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