Provider Demographics
NPI:1437797123
Name:DIXON, JULIA (EDS, NCSP)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:EDS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 DEMPSTER ST
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1155
Mailing Address - Country:US
Mailing Address - Phone:847-825-4484
Mailing Address - Fax:
Practice Address - Street 1:2601 DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1155
Practice Address - Country:US
Practice Address - Phone:847-825-4484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2024-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1844277103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL928461OtherISBE
43230OtherNASP
IL1844277OtherISBE