Provider Demographics
NPI:1154955177
Name:DIXON, SHIKI TYWAN (M A CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SHIKI
Middle Name:TYWAN
Last Name:DIXON
Suffix:
Gender:F
Credentials:M A CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 MITCHAM ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-1239
Mailing Address - Country:US
Mailing Address - Phone:318-278-4264
Mailing Address - Fax:318-254-0753
Practice Address - Street 1:1418 MITCHAM ORCHARD RD
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-1239
Practice Address - Country:US
Practice Address - Phone:318-278-4264
Practice Address - Fax:318-254-0753
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5433235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist