Provider Demographics
NPI:1467005264
Name:DIXON, JAMEY KATHERINE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JAMEY
Middle Name:KATHERINE
Last Name:DIXON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 SANTA CLARA AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-1319
Mailing Address - Country:US
Mailing Address - Phone:510-433-0123
Mailing Address - Fax:510-433-0133
Practice Address - Street 1:55 SANTA CLARA AVE STE 203
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-1319
Practice Address - Country:US
Practice Address - Phone:510-433-0123
Practice Address - Fax:510-433-0133
Is Sole Proprietor?:No
Enumeration Date:2019-07-20
Last Update Date:2019-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP23600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist