Provider Demographics
NPI:1003437559
Name:DIXON, LAUREN MARIAH (CF-SLP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MARIAH
Last Name:DIXON
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4302 W COTTAGE ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-7907
Mailing Address - Country:US
Mailing Address - Phone:479-936-0723
Mailing Address - Fax:
Practice Address - Street 1:956 MATHIAS DR
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-0985
Practice Address - Country:US
Practice Address - Phone:479-419-9911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist