Provider Demographics
NPI:1376186585
Name:LEE, DAWN MARIE (MHP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:LEE
Suffix:
Gender:F
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E MCCORD ST
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801-3702
Mailing Address - Country:US
Mailing Address - Phone:618-532-4311
Mailing Address - Fax:618-532-4316
Practice Address - Street 1:1400 E MCCORD ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-3702
Practice Address - Country:US
Practice Address - Phone:618-532-4311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2311Medicaid