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General NPI Number Information
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NPI Number | 1437285897
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Entity Type | Organization
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Legal Business Name | DIXIE H DODGE PHD PC
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 11/26/2007
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Provider Practice Location Address
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Address Line | 219 EAST ST VRAIN
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903
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Country | US
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Telephone | 719-636-2669
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Fax | 719-577-9656
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Provider Business Mailing Address
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Address Line | 219 EAST ST VRAIN
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903
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Country | US
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Telephone | 719-636-2669
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Fax | 719-577-9656
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DIXIE H DODGE
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Credential | PHD PSYCHOLOGY
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Telephone | 719-636-2669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1171
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License Number State | CO
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