MEDICARE: KATHY ANN DIXON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	23996	FL

General Provider Information

NPI Number	:	1003628892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY ANN DIXON LCSW

Provider Business Mailing Address
First Line	:	180 LIFESTYLE BLVD APT 117
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-5623
Country	:	US
Telephone Number	:	813-597-6976
Fax Number	:

Provider Business Practice Location Address
First Line	:	180 LIFESTYLE BLVD APT 117
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-5623
Country	:	US
Telephone Number	:	813-597-6976
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2025
Last Update Date	:	01/21/2025

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