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General NPI Number Information
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NPI Number | 1871885152
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Entity Type | Individual
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Provider Name | TRACY DIXON M.A. CCC/SLP
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Gender | Female
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Dates
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Enumeration Date | 05/05/2011
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Last Update Date | 05/05/2011
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Provider Practice Location Address
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Address Line | 3220 MIDDLE CHESHIRE RD
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City | CANANDAIGUA
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State | NY
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Zip | 14424-2470
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Country | US
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Telephone | 585-394-5070
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Fax | 585-394-9136
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Provider Business Mailing Address
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Address Line | 620 WESTFALL RD
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City | ROCHESTER
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State | NY
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Zip | 14620-4610
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Country | US
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Telephone |
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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 | 016505-1
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License Number State | NY
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