Healthcare Provider Details

I. General information

NPI: 1013238005
Provider Name (Legal Business Name): DAWN VANCE MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5320 159TH ST STE 100
OAK FOREST IL
60452-3329
US

IV. Provider business mailing address

PO BOX 764
MANTENO IL
60950-0764
US

V. Phone/Fax

Practice location:
  • Phone: 708-381-5009
  • Fax: 708-381-5026
Mailing address:
  • Phone: 708-381-5009
  • Fax: 708-381-5026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.005271
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: