Healthcare Provider Details

I. General information

NPI: 1750731295
Provider Name (Legal Business Name): DAWN LYNNETTE PARIS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 N ROLAND ST
MC BAIN MI
49657-9683
US

IV. Provider business mailing address

520 COBB ST
CADILLAC MI
49601-2588
US

V. Phone/Fax

Practice location:
  • Phone: 231-825-2643
  • Fax: 231-825-0161
Mailing address:
  • Phone: 231-876-6527
  • Fax: 231-876-6519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801092579
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: