MEDICARE: MS. KATHY ANN DIXON LPC

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	101YP2500X	Professional Counselor	LPC 632	MN

General Provider Information

NPI Number	:	1568543080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHY ANN DIXON LPC

Provider Business Mailing Address
First Line	:	8201 DOUGLAS LN N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55445-2547
Country	:	US
Telephone Number	:	763-300-9829
Fax Number	:

Provider Business Practice Location Address
First Line	:	1405 SILVER LAKE RD NW STE 17
Second Line	:
City	:	NEW BRIGHTON
State	:	MN
Zip	:	55112-9309
Country	:	US
Telephone Number	:	763-300-9829
Fax Number	:	612-814-0671

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	08/13/2019

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