Provider Demographics
NPI:1568639664
Name:LA LUZERNE, DAWN MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:LA LUZERNE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:MARIE
Other - Last Name:KALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:2231 MACCAUX DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54302-4531
Mailing Address - Country:US
Mailing Address - Phone:773-633-7593
Mailing Address - Fax:
Practice Address - Street 1:2231 MACCAUX DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54302-4531
Practice Address - Country:US
Practice Address - Phone:773-633-7593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1200-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist