Provider Demographics
NPI:1891285037
Name:DIXON, SHARON BERGMANN (CCC-SLP, CERT AVT)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:BERGMANN
Last Name:DIXON
Suffix:
Gender:F
Credentials:CCC-SLP, CERT AVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2913 RAWLINSON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-4807
Mailing Address - Country:US
Mailing Address - Phone:803-422-8650
Mailing Address - Fax:
Practice Address - Street 1:2913 RAWLINSON RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-4807
Practice Address - Country:US
Practice Address - Phone:803-422-8650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2105235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist