Provider Demographics
NPI:1891860516
Name:DIXON, ADRIA ANN (SPEECH LANGUAGE PATH)
Entity Type:Individual
Prefix:MS
First Name:ADRIA
Middle Name:ANN
Last Name:DIXON
Suffix:
Gender:F
Credentials:SPEECH LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 SOUTH 1375 EAST
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010
Mailing Address - Country:US
Mailing Address - Phone:801-884-8195
Mailing Address - Fax:
Practice Address - Street 1:451 BISHOP FEDERAL LANE
Practice Address - Street 2:CHRISTUS ST JOSEPHS VILLA
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115
Practice Address - Country:US
Practice Address - Phone:801-487-7557
Practice Address - Fax:801-468-6843
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5229153-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD6786Medicaid