MEDICARE: CHET DIXON

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	303942	MN
2	101YM0800X	Mental Health Counselor	1389	MN

General Provider Information

NPI Number	:	1447954821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHET DIXON

Provider Business Mailing Address
First Line	:	551 W LINCOLN RD
Second Line	:
City	:	NEW RICHMOND
State	:	WI
Zip	:	54017-1412
Country	:	US
Telephone Number	:	651-492-4376
Fax Number	:

Provider Business Practice Location Address
First Line	:	2318 PARK AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-3712
Country	:	US
Telephone Number	:	612-871-7443
Fax Number	:	612-871-0194

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

Provider Enumeration Date	:	03/29/2023
Last Update Date	:	03/29/2023

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Directions to “ CHET DIXON ” Practice Location

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