MEDICARE: DAWN H SIMONE PHD

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	103T00000X	Psychologist	LP0716	MN

General Provider Information

NPI Number	:	1972565992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN H SIMONE PHD

Provider Business Mailing Address
First Line	:	3033 EXCELSIOR BLVD
Second Line	:	SUITE 590
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55416-4688
Country	:	US
Telephone Number	:	612-225-6990
Fax Number	:	612-225-6994

Provider Business Practice Location Address
First Line	:	3033 EXCELSIOR BLVD
Second Line	:	SUITE 590
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55416-4688
Country	:	US
Telephone Number	:	612-225-6990
Fax Number	:	612-225-6994

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

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	07/08/2007

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Directions to “ DAWN H SIMONE PHD” Practice Location

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