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General NPI Number Information
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NPI Number | 1770204406
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Entity Type | Individual
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Provider Name | ROBERT J. DIXON PHD
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Gender | Male
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Dates
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Enumeration Date | 09/09/2022
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Last Update Date | 09/09/2022
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Provider Practice Location Address
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Address Line | 626 WESTWOOD DR
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City | ONALASKA
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State | WI
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Zip | 54650-2052
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Country | US
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Telephone | 608-385-8870
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Fax |
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Provider Business Mailing Address
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Address Line | 317 4TH ST S STE 356
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City | LA CROSSE
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State | WI
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Zip | 54601-4047
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Country | US
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Telephone | 608-385-8870
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 2263-57
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License Number State | WI
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