MEDICARE: DIXIE LEE DAVIS SCHOOL PSYCHOLOGIST

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	103TS0200X	School Psychologist	132826	OR

General Provider Information

NPI Number	:	1093667875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIXIE LEE DAVIS SCHOOL PSYCHOLOGIST

Provider Business Mailing Address
First Line	:	PO BOX 569
Second Line	:
City	:	WOODLAND
State	:	WA
Zip	:	98674-0600
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	41535 OLD HIGHWAY 30
Second Line	:
City	:	ASTORIA
State	:	OR
Zip	:	97103-8640
Country	:	US
Telephone Number	:	503-458-5993
Fax Number	:

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

Provider Enumeration Date	:	02/12/2026
Last Update Date	:	02/12/2026

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Directions to “ DIXIE LEE DAVIS SCHOOL PSYCHOLOGIST” Practice Location

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