Provider Demographics
NPI:1770754517
Name:PAXTON, DWAN HARRIS (MED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:DWAN
Middle Name:HARRIS
Last Name:PAXTON
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 NASH ST E
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-6339
Mailing Address - Country:US
Mailing Address - Phone:252-230-6947
Mailing Address - Fax:
Practice Address - Street 1:1009 NASH ST E
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-6339
Practice Address - Country:US
Practice Address - Phone:252-230-6947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist