Individual
DR. JOHN HANFORD DICKEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
465 MEMORIAL DR, POCATELLO, ID 83201-4008
(208) 282-4700
(208) 282-4696
Mailing address
465 MEMORIAL DR, POCATELLO, ID 83201-4008
(208) 282-4700
(208) 282-4696
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
944
CO
103TC0700X
Clinical Psychologist
Primary
PSY-194
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010015778
BLUE SHIELD
ID
01
—
N5012
BLUE CROSS
ID
Enumeration date
12/11/2006
Last updated
07/08/2007
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