MEDICARE: KATHRYN E DAWSON LIC PSYC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	900	WV

General Provider Information

NPI Number	:	1376654400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN E DAWSON LIC PSYC

Provider Business Mailing Address
First Line	:	1612 6TH AVE
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25703-1408
Country	:	US
Telephone Number	:	304-634-0668
Fax Number	:

Provider Business Practice Location Address
First Line	:	1612 6TH AVE
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25703-1408
Country	:	US
Telephone Number	:	304-634-0668
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	08/02/2019

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