Healthcare Provider Details

I. General information

NPI: 1700999356
Provider Name (Legal Business Name): MS. PATRICIA LOUISE DIXON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 MILITARY ST
PORT HURON MI
48060-5416
US

IV. Provider business mailing address

45833 MORCEAU DR
MACOMB MI
48044-6034
US

V. Phone/Fax

Practice location:
  • Phone: 810-987-7050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801020513
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: