Provider Demographics
NPI:1497094957
Name:DAWKINS, AVIS WHEELER (MSP, CCC)
Entity Type:Individual
Prefix:MRS
First Name:AVIS
Middle Name:WHEELER
Last Name:DAWKINS
Suffix:
Gender:F
Credentials:MSP, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 CEDAR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-4628
Mailing Address - Country:US
Mailing Address - Phone:864-577-7858
Mailing Address - Fax:864-577-7680
Practice Address - Street 1:355 CEDAR SPRINGS RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-4628
Practice Address - Country:US
Practice Address - Phone:864-577-7858
Practice Address - Fax:864-577-7680
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3963235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist