Provider Demographics
NPI:1568543080
Name:DIXON, KATHY ANN (LPC)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:ANN
Last Name:DIXON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 DOUGLAS LN N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445-2547
Mailing Address - Country:US
Mailing Address - Phone:763-300-9829
Mailing Address - Fax:
Practice Address - Street 1:1405 SILVER LAKE RD NW STE 17
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-9309
Practice Address - Country:US
Practice Address - Phone:763-300-9829
Practice Address - Fax:612-814-0671
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLPC 632101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional