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NPI Code Detail

MEDICARE: DAWN MARTINSON

MEDICARE: DAWN MARTINSON
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
1103TC0700XClinical PsychologistLP2890MN

General Provider Information

NPI Number : 1841842150
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAWN MARTINSON
Provider Business Mailing Address
First Line : 523 E 11TH ST
Second Line :
City : DULUTH
State : MN
Zip : 55805-1319
Country : US
Telephone Number : 218-349-4184
Fax Number :
Provider Business Practice Location Address
First Line : 4720 BURNING TREE RD
Second Line :
City : DULUTH
State : MN
Zip : 55811-2634
Country : US
Telephone Number : 218-623-1800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2019
Last Update Date : 07/16/2019

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