Individual
GARY L DICKINSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
2218 DERDALL DR, BROOKINGS, SD 57006-2851
(605) 271-7690
(605) 479-1349
Mailing address
791 E LAKE HENDRICKS DR, HENDRICKS, MN 56136-1204
(605) 271-7690
(605) 479-1349
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
231
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4993550
WELLMARK BLUECROSS
SD
05
—
6551103
—
SD
05
—
893248400
—
MN
Enumeration date
05/24/2006
Last updated
02/29/2012
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