Provider Demographics
NPI:1043363963
Name:GABLE, DAWN SHANER (PHD HSPP)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:SHANER
Last Name:GABLE
Suffix:
Gender:F
Credentials:PHD HSPP
Other - Prefix:MS
Other - First Name:SHANER
Other - Middle Name:DAWN
Other - Last Name:GABLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD HSPP
Mailing Address - Street 1:9000 MARFIELD CT
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47712-5417
Mailing Address - Country:US
Mailing Address - Phone:812-685-0065
Mailing Address - Fax:812-491-1929
Practice Address - Street 1:819 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1137
Practice Address - Country:US
Practice Address - Phone:812-491-1805
Practice Address - Fax:812-491-1929
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041439A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN225590AMedicare ID - Type UnspecifiedMEDICARE PART A & B