Provider Demographics
NPI:1386111060
Name:DIXON, MELISSA MARIE (PHD, MS)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:DIXON
Suffix:
Gender:F
Credentials:PHD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF UTAH, DEPT. OF PEDIATRICS
Mailing Address - Street 2:15 NORTH 2030 EAST, ROOM 2160
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84112
Mailing Address - Country:US
Mailing Address - Phone:801-585-7606
Mailing Address - Fax:
Practice Address - Street 1:PRIMARY CHILDREN'S HOSPITAL OUTPATIENT SERVICES
Practice Address - Street 2:81 SOUTH MARIO CAPECCHI DRIVE
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84113
Practice Address - Country:US
Practice Address - Phone:801-662-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2022-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10915900-2504103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist