Provider Demographics
NPI:1396073821
Name:NIXON, DAWN (PSYD)
Entity type:Individual
Prefix:DR
First Name:DAWN
Middle Name:
Last Name:NIXON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86360 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:BAYFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54814-4557
Mailing Address - Country:US
Mailing Address - Phone:715-779-5030
Mailing Address - Fax:715-779-5046
Practice Address - Street 1:88385 PIKE RD
Practice Address - Street 2:
Practice Address - City:BAYFIELD
Practice Address - State:WI
Practice Address - Zip Code:54814-4818
Practice Address - Country:US
Practice Address - Phone:715-779-5030
Practice Address - Fax:715-779-5046
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-20
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2809-057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist