Provider Demographics
NPI:1750590071
Name:NIXON, KATRINA DENISE (MACCCSLP)
Entity type:Individual
Prefix:MISS
First Name:KATRINA
Middle Name:DENISE
Last Name:NIXON
Suffix:
Gender:F
Credentials:MACCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7604 BARKWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-4104
Mailing Address - Country:US
Mailing Address - Phone:240-601-4171
Mailing Address - Fax:
Practice Address - Street 1:7604 BARKWOOD CT
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-4104
Practice Address - Country:US
Practice Address - Phone:240-601-4171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02097235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist