Healthcare Provider Details

I. General information

NPI: 1770855165
Provider Name (Legal Business Name): MS. BRIDGET ANNE DIXON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2012
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 W 6TH ST STE A
LAWRENCE KS
66044-1773
US

IV. Provider business mailing address

1525 W 6TH ST STE A
LAWRENCE KS
66044-1773
US

V. Phone/Fax

Practice location:
  • Phone: 785-842-9679
  • Fax:
Mailing address:
  • Phone: 785-842-9679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4383
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: