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NPI Code Detail

MEDICARE: DAWN HENDERSON MEYER

MEDICARE: DAWN HENDERSON MEYER
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
11041C0700XClinical Social Worker149.012685IL

General Provider Information

NPI Number : 1699817593
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAWN HENDERSON MEYER
Provider Business Mailing Address
First Line : 113 SPLENDOR CT
Second Line :
City : STILLMAN VALLEY
State : IL
Zip : 61084-9007
Country : US
Telephone Number : 815-298-9470
Fax Number :
Provider Business Practice Location Address
First Line : 300 WASHINGTON STREET
Second Line : SUITE 202
City : OREGON
State : IL
Zip : 61061-1609
Country : US
Telephone Number : 815-298-9470
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2007
Last Update Date : 05/07/2009

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