Provider Demographics
NPI:1013398585
Name:DAWLEY, COLLEEN (RD, LD)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:DAWLEY
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 20TH ST S
Mailing Address - Street 2:
Mailing Address - City:IRONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35210-1636
Mailing Address - Country:US
Mailing Address - Phone:214-454-3423
Mailing Address - Fax:
Practice Address - Street 1:2561 DAUPHIN ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-4850
Practice Address - Country:US
Practice Address - Phone:251-478-2214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1984133V00000X
1105904133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered