Provider Demographics
NPI:1518391861
Name:DAWSON, LESLIE ANN (PLPC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:DAWSON
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 S KENTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-1320
Mailing Address - Country:US
Mailing Address - Phone:417-830-8956
Mailing Address - Fax:
Practice Address - Street 1:1722 S GLENSTONE AVE
Practice Address - Street 2:STE H
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1513
Practice Address - Country:US
Practice Address - Phone:417-881-9518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013030416101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional