Provider Demographics
NPI:1356637680
Name:DIXON, LESLEY (MS)
Entity Type:Individual
Prefix:MS
First Name:LESLEY
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 CHARLES J MILLER RD
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-0710
Mailing Address - Country:US
Mailing Address - Phone:815-344-8408
Mailing Address - Fax:815-344-8425
Practice Address - Street 1:3300 CHARLES J MILLER RD
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-0710
Practice Address - Country:US
Practice Address - Phone:815-344-8408
Practice Address - Fax:815-344-8425
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3553-154235Z00000X
IL146012476235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist