Provider Demographics
NPI:1114482205
Name:DAWSON, RACHEL
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:DAWSON
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 1:2843 E IL ROUTE 170
Mailing Address - Street 2:
Mailing Address - City:RANSOM
Mailing Address - State:IL
Mailing Address - Zip Code:60470-8055
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2843 E IL ROUTE 170
Practice Address - Street 2:
Practice Address - City:RANSOM
Practice Address - State:IL
Practice Address - Zip Code:60470-8055
Practice Address - Country:US
Practice Address - Phone:815-257-4454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD250-7329-8950OtherDRIVER'S LICENSE