Provider Demographics
NPI:1083640189
Name:DAWSON, TRUDY C (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:TRUDY
Middle Name:C
Last Name:DAWSON
Suffix:
Gender:F
Credentials:MSW LCSW
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 76510
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80970-6510
Mailing Address - Country:US
Mailing Address - Phone:719-638-8844
Mailing Address - Fax:
Practice Address - Street 1:7035 CAMPUS DR
Practice Address - Street 2:STE 808
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-6527
Practice Address - Country:US
Practice Address - Phone:719-377-2118
Practice Address - Fax:877-515-7172
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9860501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO016468Medicaid
CO016468Medicaid