Provider Demographics
NPI:1578889929
Name:WOOLSTON, DIXIE JEAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIXIE
Middle Name:JEAN
Last Name:WOOLSTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13400 E SHEA BLVD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-5452
Mailing Address - Country:US
Mailing Address - Phone:480-301-6874
Mailing Address - Fax:
Practice Address - Street 1:1020 E 2ND ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2946
Practice Address - Country:US
Practice Address - Phone:307-265-4343
Practice Address - Fax:307-234-6339
Is Sole Proprietor?:No
Enumeration Date:2010-04-09
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103G00000X
AZPSY-005096103TC0700X
WY542103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist