Provider Demographics
NPI:1346258449
Name:DAWSON, PHYLLIS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:
Last Name:DAWSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:666 DUNDEE RD STE 1302
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2736
Mailing Address - Country:US
Mailing Address - Phone:224-326-0025
Mailing Address - Fax:847-400-5828
Practice Address - Street 1:666 DUNDEE RD STE 1302
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2736
Practice Address - Country:US
Practice Address - Phone:224-326-0025
Practice Address - Fax:847-400-5828
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-006488103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical