Individual
JOHNATHAN BRADLEY DICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSP SLP-CFY
Contact information
Practice address
880 CAROLINA AVE, SUMTER, SC 29150-2815
(803) 775-5394
Mailing address
110 ANNIE CT, DALZELL, SC 29040-9010
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
6733
SC
Other
Enumeration date
05/15/2019
Last updated
05/15/2019
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