Provider Demographics
NPI:1417416108
Name:DIXSON, KELSEY M (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:M
Last Name:DIXSON
Suffix:
Gender:
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:M
Other - Last Name:LUCAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:76 NORTHEASTERN BLVD STE 40
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-3174
Mailing Address - Country:US
Mailing Address - Phone:603-882-4500
Mailing Address - Fax:
Practice Address - Street 1:76 NORTHEASTERN BLVD STE 40
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-3174
Practice Address - Country:US
Practice Address - Phone:603-882-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1889235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist