Healthcare Provider Details

I. General information

NPI: 1366652653
Provider Name (Legal Business Name): DAWN ANGELEN SCOVEL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 10/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 VINCENT ST ATTN: 21MDOS/SGOH
COLORADO SPRINGS CO
80914-1541
US

IV. Provider business mailing address

559 VINCENT ST ATTN: 21MDOS/SGOH
PETERSON AFB CO
80914
US

V. Phone/Fax

Practice location:
  • Phone: 719-556-7804
  • Fax: 719-556-7399
Mailing address:
  • Phone: 719-556-7804
  • Fax: 719-556-7399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1385
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: