Provider Demographics
NPI:1962665109
Name:DIXON, ALECIA LYNN (MS)
Entity type:Individual
Prefix:
First Name:ALECIA
Middle Name:LYNN
Last Name:DIXON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22275 DAUNTLESS DR NW UNIT 108
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-4009
Mailing Address - Country:US
Mailing Address - Phone:314-920-1523
Mailing Address - Fax:
Practice Address - Street 1:9000 NE WEST KINGSTON RD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:WA
Practice Address - Zip Code:98346-9327
Practice Address - Country:US
Practice Address - Phone:314-920-1523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDTSLP-1747235Z00000X
MO2009036119235Z00000X
WALL60299421235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist