Provider Demographics
NPI:1366828634
Name:DIXON, SAMANTHA (AUD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 809094
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680-9094
Mailing Address - Country:US
Mailing Address - Phone:773-296-5500
Mailing Address - Fax:773-296-3800
Practice Address - Street 1:5758 S MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1426
Practice Address - Country:US
Practice Address - Phone:773-702-1865
Practice Address - Fax:773-834-1117
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147001552231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist