DR. TERRY MARC DICKSON (NPI# 1851505978) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851505978 |
| Entity Type | Individual |
| Full Name | DR. TERRY MARC DICKSON |
| Credential | M.D. |
| Practice Address |
745 S Garfield Ave Suite C Traverse City MI 49686-3479 |
| Practice Telephone | 2319321250 |
| Practice Fax Number | 2319321266 |
| Mailing Telephone | 2319321250 |
| Mailing Fax Number | 2319321266 |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2013-08-27 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0006X |
Pediatrics Specialization: Developmental – Behavioral Pediatrics |
4301062201 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 104467082 | 05 | |
| MI | BLUE CROSS BLUE SHIELD MI | 0280327 | 01 |
| Street Address |
745 S GARFIELD AVE SUITE C |
| City | TRAVERSE CITY |
| State | MI |
| Zip Code | 49686-3479 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023259496 | Janet Margaret Morency | Audiologist | 745 S Garfield Ave, Traverse City, MI 49686-5500 | 2009-03-16 |
| 1154567279 | The Behavioral Medicine Clinic of Northwest Michigan, P.C. | Clinic/Center | 745 S Garfield Ave, Suite C, Traverse City, MI 49686-3479 | 2008-12-18 |
| 1336353473 | The Behavioral Medicine Clinic of Northwest Michigan, Plc | Pediatrics | 745 S Garfield Ave, Suite C, Traverse City, MI 49686-3479 | 2007-05-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245877208 | Jessica Marie Glowacki | Behavior Technician | 935 Hemlock St, Traverse City, MI 49686 | 2019-12-09 |
| 1568011542 | Joanne Kressley | Technician | 1693 Maylane Apt. 104, Traverse City, MI 49686 | 2019-09-11 |
| 1194283846 | Pace North | PACE Provider Organization | 2325 Garfield Road N., Traverse City, MI 49686 | 2019-03-12 |
| 1245749225 | Margaret Anne Goss | Speech-Language Pathologist | 1105 E. Eighth Street, Traverse City, MI 49686 | 2017-09-22 |
| 1467981811 | Joan Joyce Shirilla | Social Worker | 2124 Twin Eagles Dr, Traverse City, MI 49686 | 2017-06-08 |
| 1770028763 | Rehab and Mobility Systems, LLC | Durable Medical Equipment & Medical Supplies | 707 Parsons, Traverse City, MI 49686 | 2016-12-29 |
| 1629511316 | Kaitlyn Grangood | Social Worker | 415 Munson Avenue, Ste 101, Traverse City, MI 49686 | 2016-11-29 |
| 1811441132 | Jeffrey D Goodwin | Counselor | 430 Fair St., Traverse City, MI 49686 | 2016-08-04 |
| 1053779918 | Thomas Osborne | Counselor | 2014 Phelps Rd., Traverse City, MI 49686 | 2016-02-08 |
| 1982079588 | Marsha Lynne Dallas | Counselor | 2240 South Airport Road, Traverse City, MI 49686 | 2015-12-08 |
| Find all providers in zip 49686 | ||||
| Taxonomy Code | 2080P0006X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Developmental – Behavioral Pediatrics |
| A developmental-behavioral specialist is a pediatrician with special training and experience who aims to foster understanding and promotion of optimal development of children and families through research, education, clinical care and advocacy efforts. This physician assists in the prevention, diagnosis, and management of developmental difficulties and problematic behaviors in children and in the family dysfunctions that compromise children's development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source changed, 3/26/2008: definition corrected] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336353473 | The Behavioral Medicine Clinic of Northwest Michigan, Plc | Pediatrics | 745 S Garfield Ave, Suite C, Traverse City, MI 49686-3479 | 2007-05-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023177268 | Robert Bulten | Pediatrics | 4340 Burlingame Ave Sw, Wyoming, MI 49509-3770 | 2006-12-06 |
| 1144313107 | Cheryl Hope Hack | Pediatrics | 30301 Woodward Ave, Suite Ll 165, Royal Oak, MI 48073-0979 | 2006-10-02 |
| 1063449247 | Marsha Dawn Rappley | Pediatrics | A110 Clinical Ctr, 138 Service Rd, East Lansing, MI 48824-1313 | 2006-06-26 |
| 1073093290 | Rose Margret Thacker | Pediatrics | 32100 Telegraph Rd Ste 185, Bingham Farms, MI 48025-2453 | 2018-08-16 |
| 1073024469 | Alison Campos | Pediatrics | 3111 Electric Ave, Port Huron, MI 48060-8127 | 2017-10-12 |
| 1114375292 | Nicole Patrice Hamp | Pediatrics | 1500 E Medical Center Dr, Ann Arbor, MI 48109-5718 | 2016-05-30 |
| 1487068383 | Robin Johnson Cook | Pediatrics | 35 Michigan St Ne Ste 3003, Grand Rapids, MI 49503-2528 | 2014-06-18 |
| 1134431968 | Meghan Ruth Behrmann | Pediatrics | 35 Michigan St Ne, Suite 3003, Grand Rapids, MI 49503-2514 | 2010-07-09 |
| 1457566382 | William Beaumont Hospital | Pediatrics | 3601 W 13 Mile Rd, Fsc, Royal Oak, MI 48073-6712 | 2007-05-14 |
| 1568558229 | Mark Alan Sloane | Pediatrics | 700 Mall Dr, Suite C, Portage, MI 49024-1800 | 2006-10-04 |
| Find all providers with the same taxonomy | ||||
| City | TRAVERSE CITY |
| Zip Code | 49686 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.