Provider Demographics
NPI:1578042255
Name:DIXON, CARLY (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
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 1:9999 W KATIE AVE UNIT 2257
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-8371
Mailing Address - Country:US
Mailing Address - Phone:702-401-0477
Mailing Address - Fax:
Practice Address - Street 1:9121 W RUSSELL RD STE 118
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-1238
Practice Address - Country:US
Practice Address - Phone:702-262-7490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist