Individual
JESSICA L DICKENMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPRS
Contact information
Practice address
185 ROUTE 36 BLDG E, WEST LONG BRANCH, NJ 07764-1341
(732) 571-2190
Mailing address
PO BOX 2036, LAKEWOOD, NJ 08701-8036
(732) 367-4700
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
50691
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0029807
—
NJ
Enumeration date
04/30/2024
Last updated
04/30/2024
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