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NPI Code Detail

MEDICARE: DAWN HARRIS

MEDICARE: DAWN HARRIS
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1073151098
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAWN HARRIS
Provider Business Mailing Address
First Line : 2755 N PINE GROVE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60614-6109
Country : US
Telephone Number : 312-259-2665
Fax Number :
Provider Business Practice Location Address
First Line : 2755 N PINE GROVE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60614-6109
Country : US
Telephone Number : 312-259-2665
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2019
Last Update Date : 12/20/2019

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