Most Relevant Information
Provider Data
| NPI Number: | 1003585308 |
| Provider Name: | TIAWANA E DICKERSON |
| Entity Type: | Individual |
| Taxonomy Code: | 175T00000X |
| Specialty: | Peer Specialist |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/09/2021 |
| Last Updated: | 09/09/2021 |
Provider Practice Location
1007 KOALA DR
OMAK
WA
988419247
Practice Location Phone/Fax
| Phone: | 5098266191 |
| Fax: | 5098263029 |
Provider Mailing Location
1007 KOALA DR
OMAK
WA
988419247
Provider Mailing Phone/Fax
| Phone: | 5098266191 |
| Fax: | 5098263029 |