Provider Demographics
NPI:1255483343
Name:BEREZNAK, DAWN RENEE (MA-CCC)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:RENEE
Last Name:BEREZNAK
Suffix:
Gender:F
Credentials:MA-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 FROSTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ALMANOR
Mailing Address - State:CA
Mailing Address - Zip Code:96137-9646
Mailing Address - Country:US
Mailing Address - Phone:530-520-7179
Mailing Address - Fax:530-259-6024
Practice Address - Street 1:13 STRATFORD WAY
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-8111
Practice Address - Country:US
Practice Address - Phone:530-520-7179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP11142235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist