Provider Demographics
NPI:1336017094
Name:WIXON, ROBERT ALEXANDER
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ALEXANDER
Last Name:WIXON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4318 S 41ST ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-2165
Mailing Address - Country:US
Mailing Address - Phone:575-637-0333
Mailing Address - Fax:
Practice Address - Street 1:4318 S 41ST ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-2165
Practice Address - Country:US
Practice Address - Phone:575-637-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-24
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician