Provider Demographics
NPI:1235243056
Name:LORD, DAWN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:
Last Name:LORD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 FOREST VIEW DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-2700
Mailing Address - Country:US
Mailing Address - Phone:330-836-4840
Mailing Address - Fax:
Practice Address - Street 1:2810 FOREST VIEW DR
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-2700
Practice Address - Country:US
Practice Address - Phone:330-836-4840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3137103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0480537Medicaid
OH0480537Medicaid