Female

Pauline Dickerson LSW

Full Name

Pauline Dickerson LSW

NPI Number

1518057975

NPI Type

Individual Provider

Gender

Female

Enumeration Date

10/13/2006

Specialties

(Taxonomies)

Code

171M00000X
104100000X

Primary Taxonomy

No
No

Licenses

State

North Dakota

License Number

2400

Contact
Information

Purpose

Mailing
Location

Address

1237 W DIVIDE AVE
1237 W DIVIDE AVE

City

Bismarck
Bismarck

State

ND
ND

Postal Code

58501-1208
58501-1208

Country

US
US

Telephone Number

(701) 328-8819
(701) 328-8819

Identifiers

Identifier

17857

Identifier State

ND

Identifier Issuer

BCBS

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 07/08/2007

Provider Address