MEDICARE: MS. DAWN ELAINE CHALKER LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	6401003447	MI

General Provider Information

NPI Number	:	1013160662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DAWN ELAINE CHALKER LPC

Provider Business Mailing Address
First Line	:	2050 WASHTENAW RD
Second Line	:
City	:	YPSILANTI
State	:	MI
Zip	:	48197-1706
Country	:	US
Telephone Number	:	734-417-2664
Fax Number	:

Provider Business Practice Location Address
First Line	:	2050 WASHTENAW RD
Second Line	:
City	:	YPSILANTI
State	:	MI
Zip	:	48197-1706
Country	:	US
Telephone Number	:	734-417-2664
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2008
Last Update Date	:	10/28/2008

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