Provider Demographics
NPI:1689866907
Name:DIXON, SANDRA JO (LMSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JO
Last Name:DIXON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12351 W 96TH TER
Mailing Address - Street 2:300
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-4409
Mailing Address - Country:US
Mailing Address - Phone:913-894-0900
Mailing Address - Fax:913-894-0908
Practice Address - Street 1:12351 W 96TH TER
Practice Address - Street 2:300
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-4409
Practice Address - Country:US
Practice Address - Phone:913-894-0900
Practice Address - Fax:913-894-0908
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMSW2075104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker