Healthcare Provider Details

I. General information

NPI: 1093533812
Provider Name (Legal Business Name): DAWN GORE MEADOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAWN GORE MEADOR IPE, CCTP

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2627 CHARLESTOWN RD
NEW ALBANY IN
47150-2536
US

IV. Provider business mailing address

11436 E STATE ROAD 160
SALEM IN
47167-7641
US

V. Phone/Fax

Practice location:
  • Phone: 463-900-8396
  • Fax:
Mailing address:
  • Phone: 812-786-0452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1585300
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: