Provider Demographics
NPI:1619927498
Name:LAURENT, DAWN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:
Last Name:LAURENT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 W MILWAUKEE ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-2998
Mailing Address - Country:US
Mailing Address - Phone:773-879-1892
Mailing Address - Fax:608-756-3463
Practice Address - Street 1:1820 CENTER AVENUE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546
Practice Address - Country:US
Practice Address - Phone:608-755-1475
Practice Address - Fax:608-755-1733
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-006404103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL364099911OtherEIN