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General NPI Number Information
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NPI Number | 1831462456
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Entity Type | Individual
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Provider Name | DEANNA MICHELLE DIXON
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Gender | Female
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Dates
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Enumeration Date | 02/13/2012
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Last Update Date | 02/13/2012
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Provider Practice Location Address
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Address Line | 1015 WATERWOOD PKWY STE G-B2
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City | EDMOND
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State | OK
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Zip | 73034-5355
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Country | US
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Telephone | 405-388-3203
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Fax |
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Provider Business Mailing Address
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Address Line | 2408 NW 115TH ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-7311
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Country | US
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Telephone | 405-388-3203
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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