Provider Demographics
NPI:1407268303
Name:JETER, DAWN (BEHAVIOR SPECIALIST)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:
Last Name:JETER
Suffix:
Gender:F
Credentials:BEHAVIOR SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6658 FAIR SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:PA
Mailing Address - Zip Code:17327-7848
Mailing Address - Country:US
Mailing Address - Phone:717-235-2827
Mailing Address - Fax:
Practice Address - Street 1:1195 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404-2350
Practice Address - Country:US
Practice Address - Phone:717-843-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA103K00000X101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABH000383OtherBUREAU OF PROFESSINAL AND OCCUPATIONAL AFFAIRS