Provider Demographics
NPI:1073285789
Name:DIXSON, LAURA MARIE (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:DIXSON
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 WAINWRIGHT DR BLDG 135
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3975
Mailing Address - Country:US
Mailing Address - Phone:509-525-5200
Mailing Address - Fax:
Practice Address - Street 1:77 WAINWRIGHT DR BLDG 135
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3975
Practice Address - Country:US
Practice Address - Phone:509-525-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW0113391041C0700X, 1041C0700X
WALW615308131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical