Individual
RUSSELL LOUIS DIXON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
1500 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-3318
(573) 686-4151
Mailing address
1500 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-3318
(573) 686-4151
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
90-09P
AR
103T00000X
Psychologist
90-09P
AR
103TC0700X
Clinical Psychologist
90-09P
AR
Other
Enumeration date
09/28/2011
Last updated
08/15/2013
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