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General NPI Number Information
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NPI Number | 1427606136
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Entity Type | Organization
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Legal Business Name | THE DAWN GODDESS LLC
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Dates
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Enumeration Date | 08/27/2019
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Last Update Date | 08/27/2019
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Provider Practice Location Address
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Address Line | 1010 S CASCADE AVE STE E
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City | MONTROSE
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State | CO
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Zip | 81401-4980
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Country | US
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Telephone | 970-465-2714
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Fax | 970-230-5913
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Provider Business Mailing Address
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Address Line | 236 S 3RD ST # 308
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City | MONTROSE
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State | CO
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Zip | 81401-3618
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Country | US
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Telephone | 970-465-2714
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Fax | 970-230-5913
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Authorized Official
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Title or Position | OWNER
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Name | AMIESSA DAWN JUTTEN
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Credential | LCSW
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Telephone | 970-465-2714
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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