Healthcare Provider Details

I. General information

NPI: 1790780583
Provider Name (Legal Business Name): LESLIE DIXON MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 02/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N KEEL RIDGE RD
HERMITAGE PA
16148-3440
US

IV. Provider business mailing address

102 N KEEL RIDGE RD
HERMITAGE PA
16148-3440
US

V. Phone/Fax

Practice location:
  • Phone: 800-471-8592
  • Fax:
Mailing address:
  • Phone: 800-471-8592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAT-001085-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: