Provider Demographics
NPI:1366694937
Name:HUBER, DAWN HEATHER (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:HEATHER
Last Name:HUBER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:175 S MARSHALL ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:ROGERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65742-8828
Mailing Address - Country:US
Mailing Address - Phone:417-753-1963
Mailing Address - Fax:417-753-9405
Practice Address - Street 1:175 S MARSHALL ST
Practice Address - Street 2:SUITE G
Practice Address - City:ROGERSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65742-8828
Practice Address - Country:US
Practice Address - Phone:417-753-1963
Practice Address - Fax:417-753-9405
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2008011433103G00000X, 103TB0200X, 103TM1800X, 103TS0200X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1366694937Medicaid