Provider Demographics
NPI:1427507474
Name:DIXON, DANIELLE (SLP)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4179 ACADEMIC DR APT C
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-3782
Mailing Address - Country:US
Mailing Address - Phone:252-671-5415
Mailing Address - Fax:
Practice Address - Street 1:1330 E ARLINGTON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-7850
Practice Address - Country:US
Practice Address - Phone:252-758-7048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10934235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist