Provider Demographics
NPI:1770204406
Name:DIXON, ROBERT J (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:DIXON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 4TH ST S STE 356
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-4047
Mailing Address - Country:US
Mailing Address - Phone:608-385-8870
Mailing Address - Fax:
Practice Address - Street 1:626 WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-2052
Practice Address - Country:US
Practice Address - Phone:608-385-8870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2263-57103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent