MEDICARE: KAITLYN DIXON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1356744965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN DIXON LCSW

Provider Business Mailing Address
First Line	:	2943 W PARKWAY BLVD UNIT 205
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84119-1986
Country	:	US
Telephone Number	:	385-645-1915
Fax Number	:

Provider Business Practice Location Address
First Line	:	2943 W PARKWAY BLVD UNIT 205
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84119-1986
Country	:	US
Telephone Number	:	385-645-1915
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2014
Last Update Date	:	11/08/2023

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