Healthcare Provider Details

I. General information

NPI: 1801861869
Provider Name (Legal Business Name): DIXIE ANN HEUTON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 04/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 30TH ST
DES MOINES IA
50310-5753
US

IV. Provider business mailing address

318 NE BEL AIRE RD
ANKENY IA
50021-1918
US

V. Phone/Fax

Practice location:
  • Phone: 515-699-5999
  • Fax:
Mailing address:
  • Phone: 515-964-5833
  • Fax: 515-964-5833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number543
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number001279
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: