Healthcare Provider Details

I. General information

NPI: 1811618929
Provider Name (Legal Business Name): DAWN C BROSE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. DAWN CHRISTINE BENNETT

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7905 N MEADOWLARK WAY STE B
COEUR D ALENE ID
83815-5041
US

IV. Provider business mailing address

PO BOX 1387
HAYDEN ID
83835-1387
US

V. Phone/Fax

Practice location:
  • Phone: 208-772-3116
  • Fax: 208-772-7677
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-42332
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8911046
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: