Provider Demographics
NPI:1083358543
Name:MADDEN, DAWN
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:MADDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50207
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84605-0207
Mailing Address - Country:US
Mailing Address - Phone:702-659-9043
Mailing Address - Fax:
Practice Address - Street 1:4626 N 300 W STE 150
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-6077
Practice Address - Country:US
Practice Address - Phone:801-407-4134
Practice Address - Fax:801-877-0864
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional