Provider Demographics
NPI:1639054679
Name:DIXON, HALEY MICHELLE
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:MICHELLE
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 1:2225 TICKY FORK DR
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:KY
Mailing Address - Zip Code:40472-8780
Mailing Address - Country:US
Mailing Address - Phone:606-975-6153
Mailing Address - Fax:
Practice Address - Street 1:116 MERIDIAN WAY STE 8
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2876
Practice Address - Country:US
Practice Address - Phone:859-353-8382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY299431235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist