Provider Demographics
NPI:1770855165
Name:DIXON, BRIDGET ANNE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:BRIDGET
Middle Name:ANNE
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 1:1525 W 6TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1773
Mailing Address - Country:US
Mailing Address - Phone:785-842-9679
Mailing Address - Fax:
Practice Address - Street 1:1525 W 6TH ST STE A
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1773
Practice Address - Country:US
Practice Address - Phone:785-842-9679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7702104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker