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General NPI Number Information
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NPI Number | 1992862684
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Entity Type | Individual
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Provider Name | KIM DIXON JOHNSON LP
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Gender | Male
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 714 W COLLEGE ST
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City | DULUTH
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State | MN
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Zip | 55811-4906
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Country | US
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Telephone | 218-728-7164
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Fax | 218-724-0251
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Provider Business Mailing Address
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Address Line | 2115 APPALACHIAN ST
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City | DULUTH
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State | MN
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Zip | 55811-3121
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Country | US
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Telephone | 218-624-3697
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | LP 3401
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License Number State | MN
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