Provider Demographics
NPI:1285454074
Name:DIXON, ANNA (MCD, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:SHANKLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MCD, CCC-SLP
Mailing Address - Street 1:1783 THOMAS TER
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-4636
Mailing Address - Country:US
Mailing Address - Phone:318-773-0767
Mailing Address - Fax:
Practice Address - Street 1:1783 THOMAS TER
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-4636
Practice Address - Country:US
Practice Address - Phone:318-773-0767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP012879235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist