Provider Demographics
NPI:1134827942
Name:DIXON, BRANDI (RBT)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11401 BLUEGRASS PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-2349
Mailing Address - Country:US
Mailing Address - Phone:888-515-1793
Mailing Address - Fax:502-297-0289
Practice Address - Street 1:4410 EXECUTIVE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46808-1135
Practice Address - Country:US
Practice Address - Phone:888-515-1793
Practice Address - Fax:502-297-0289
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-22-212088106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician