Provider Demographics
NPI:1407405558
Name:NIXON, ADAM
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:NIXON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6120 E 5TH ST UNIT B137
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2529
Mailing Address - Country:US
Mailing Address - Phone:503-515-4307
Mailing Address - Fax:
Practice Address - Street 1:3200 S LEAD FLOWER AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85735-8686
Practice Address - Country:US
Practice Address - Phone:520-908-5760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP11923235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist