Provider Demographics
NPI:1538155353
Name:JEANNE DIXON COUNSELING SERVICES
Entity type:Organization
Organization Name:JEANNE DIXON COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, CSAC
Authorized Official - Phone:715-735-0227
Mailing Address - Street 1:2619 HANNAH ST.
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-1504
Mailing Address - Country:US
Mailing Address - Phone:715-735-0227
Mailing Address - Fax:715-735-7394
Practice Address - Street 1:1712 DUNLAP AVE
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-1709
Practice Address - Country:US
Practice Address - Phone:715-735-0227
Practice Address - Fax:715-735-7394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2578251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42240400Medicaid