Provider Demographics
NPI:1508411885
Name:HAWHEE, DYLAN (LAC)
Entity Type:Individual
Prefix:MS
First Name:DYLAN
Middle Name:
Last Name:HAWHEE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:CARRIE
Other - Middle Name:LEANNE
Other - Last Name:HAWHEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1219
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95473-1219
Mailing Address - Country:US
Mailing Address - Phone:707-861-0783
Mailing Address - Fax:
Practice Address - Street 1:95 MONTGOMERY DR STE 90
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-6617
Practice Address - Country:US
Practice Address - Phone:707-861-0783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17560171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist