Healthcare Provider Details

I. General information

NPI: 1558298620
Provider Name (Legal Business Name): SYRAI SYMONE MCKENZIE-DIXON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16150 CICERO AVE STE 12
OAK FOREST IL
60452-4136
US

IV. Provider business mailing address

16150 CICERO AVE STE 12
OAK FOREST IL
60452-4136
US

V. Phone/Fax

Practice location:
  • Phone: 708-439-3437
  • Fax:
Mailing address:
  • Phone: 708-439-3437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: