MEDICARE: MEGAN E DIXON LISW-S

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	I.1600787-SUPV	OH

General Provider Information

NPI Number	:	1558764043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN E DIXON LISW-S

Provider Business Mailing Address
First Line	:	100 ELMWOOD PARK DR STE 201
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45449-5402
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 ELMWOOD PARK DR STE 201
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45449-5402
Country	:	US
Telephone Number	:	937-384-0580
Fax Number	:

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

Provider Enumeration Date	:	09/29/2014
Last Update Date	:	09/18/2019

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