MEDICARE: ALICIA KRISTEN-MARIE DAWSON MSSW

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	101YM0800X	Mental Health Counselor
2	104100000X	Social Worker

General Provider Information

NPI Number	:	1174052930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA KRISTEN-MARIE DAWSON MSSW

Provider Business Mailing Address
First Line	:	4902 CHISMOOR CT
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40258-3629
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2820 GRANT LINE RD
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-2494
Country	:	US
Telephone Number	:	812-981-2594
Fax Number	:

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

Provider Enumeration Date	:	06/06/2017
Last Update Date	:	06/06/2017

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