Provider Demographics
NPI:1679727754
Name:DIXON, HEATHER LAVELLE
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LAVELLE
Last Name:DIXON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 SW SHIRLEY ANN DR
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-7665
Mailing Address - Country:US
Mailing Address - Phone:503-472-4055
Mailing Address - Fax:503-472-9999
Practice Address - Street 1:1525 SW SHIRLEY ANN DR
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-7665
Practice Address - Country:US
Practice Address - Phone:503-472-4055
Practice Address - Fax:503-472-9999
Is Sole Proprietor?:No
Enumeration Date:2008-11-16
Last Update Date:2008-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator