Provider Demographics
NPI:1225420037
Name:DIXON, AMANDA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMANDA
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 1:255 OAK TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:DOUBLE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75077-8252
Mailing Address - Country:US
Mailing Address - Phone:619-361-9636
Mailing Address - Fax:
Practice Address - Street 1:255 OAK TRAIL DR
Practice Address - Street 2:
Practice Address - City:DOUBLE OAK
Practice Address - State:TX
Practice Address - Zip Code:75077-8252
Practice Address - Country:US
Practice Address - Phone:619-361-9636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-03
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASPA 26602355S0801X
TX116052235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant