Healthcare Provider Details

I. General information

NPI: 1962197780
Provider Name (Legal Business Name): EMILY DIANE DIXSON CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY DIANE LANDRY

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6755 PHELAN BLVD STE 38
BEAUMONT TX
77706-6078
US

IV. Provider business mailing address

6645 WOODRIDGE DR
ORANGE TX
77632-5703
US

V. Phone/Fax

Practice location:
  • Phone: 409-554-0689
  • Fax: 409-554-0483
Mailing address:
  • Phone: 409-781-9942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: