Provider Demographics
NPI:1184037350
Name:DIXON, MONICA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 LANTERN VIEW LN
Mailing Address - Street 2:
Mailing Address - City:SCOTTDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30079-6804
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4500 SATELLITE BLVD
Practice Address - Street 2:SUITE 2290
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5037
Practice Address - Country:US
Practice Address - Phone:800-381-2195
Practice Address - Fax:888-381-0822
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007569235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist