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General NPI Number Information
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NPI Number | 1386470748
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Entity Type | Individual
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Provider Name | DAWN RENEE POOLE M.E., EDS
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Gender | Female
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Dates
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Enumeration Date | 09/11/2024
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 1801 S 18TH ST
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City | LAFAYETTE
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State | IN
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Zip | 47905-2011
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Country | US
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Telephone | 765-772-4700
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Fax | 765-772-4713
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Provider Business Mailing Address
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Address Line | 1840 S 18TH ST
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City | LAFAYETTE
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State | IN
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Zip | 47905-2012
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Country | US
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Telephone | 765-772-4700
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Fax | 765-772-4775
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 1410699
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License Number State | IN
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