Healthcare Provider Details

I. General information

NPI: 1861300907
Provider Name (Legal Business Name): NICOLE DIXON MA CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5750 ACADEMIC WAY
HASLETT MI
48840-5005
US

IV. Provider business mailing address

7503 ROUND LAKE RD
LAINGSBURG MI
48848-9503
US

V. Phone/Fax

Practice location:
  • Phone: 517-339-8208
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101009180
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: