MEDICARE: DR. DIXIE DOREEN HU

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	103TC0700X	Clinical Psychologist	P.08481	OH

General Provider Information

NPI Number	:	1336828938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIXIE DOREEN HU

Provider Business Mailing Address
First Line	:	4041 N HIGH ST STE 102
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-3248
Country	:	US
Telephone Number	:	614-931-0228
Fax Number	:

Provider Business Practice Location Address
First Line	:	4041 N HIGH ST STE 102
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-3248
Country	:	US
Telephone Number	:	614-931-0228
Fax Number	:

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

Provider Enumeration Date	:	07/12/2023
Last Update Date	:	07/12/2023

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