Individual
MICHELLE LYNN DIX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CHW
Contact information
Practice address
3425 13TH ST, BAKER CITY, OR 97814-1340
(541) 523-7400
(541) 523-4937
Mailing address
3425 13TH ST, BAKER CITY, OR 97814-1340
(541) 523-7400
(541) 523-4937
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
22-QMHA-I-003286
OR
172V00000X
Community Health Worker
Primary
THW000000007
OR
172V00000X
Community Health Worker
THW0047
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4276768
DRIVERS LICENSE
OR
05
—
500776546
—
OR
05
—
500813182
—
OR
Enumeration date
02/18/2020
Last updated
07/13/2023
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