Provider Demographics
NPI:1174276893
Name:PHILBIN, DAWN RENAE (SLP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:RENAE
Last Name:PHILBIN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 S 68TH ST STE 1101
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8304
Mailing Address - Country:US
Mailing Address - Phone:515-218-8445
Mailing Address - Fax:515-864-0024
Practice Address - Street 1:160 S 68TH ST STE 1101
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8304
Practice Address - Country:US
Practice Address - Phone:515-218-8445
Practice Address - Fax:515-864-0024
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-1990235Z00000X
OR016551235Z00000X
NC30000187235Z00000X
IA01709235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA15481618OtherCAQH