Provider Demographics
NPI:1447565031
Name:BIRCHENOUGH, DAWN THEREASA (MA, LISW)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:THEREASA
Last Name:BIRCHENOUGH
Suffix:
Gender:F
Credentials:MA, LISW
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:T
Other - Last Name:CORTEZ MCKEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LSW
Mailing Address - Street 1:221 W LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2217
Mailing Address - Country:US
Mailing Address - Phone:330-722-4166
Mailing Address - Fax:
Practice Address - Street 1:1622 E TURKEYFOOT LAKE RD STE 100
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-5277
Practice Address - Country:US
Practice Address - Phone:330-543-5015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-08
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.18009041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical