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General NPI Number Information
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NPI Number | 1578042255
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Entity Type | Individual
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Provider Name | CARLY DIXON MS, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/13/2018
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Last Update Date | 06/25/2019
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Provider Practice Location Address
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Address Line | 9121 W RUSSELL RD STE 118
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City | LAS VEGAS
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State | NV
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Zip | 89148-1238
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Country | US
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Telephone | 702-262-7490
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Fax |
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Provider Business Mailing Address
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Address Line | 9999 W KATIE AVE UNIT 2257
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City | LAS VEGAS
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State | NV
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Zip | 89147-8371
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Country | US
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Telephone | 702-401-0477
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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