Provider Demographics
NPI:1275952152
Name:DIXON, KRISTEN (SLP-A)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6002 DIAMOND RUBY STE 3 PMB 658
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00820-5226
Mailing Address - Country:US
Mailing Address - Phone:340-626-7853
Mailing Address - Fax:
Practice Address - Street 1:4A & 4AA LAGRANDE PRINCESSE
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-5226
Practice Address - Country:US
Practice Address - Phone:340-626-7853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-08
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI 22792355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant