Provider Demographics
NPI:1629180369
Name:BROERS, DAWN R (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:R
Last Name:BROERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:R
Other - Last Name:RANDAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:183 E BETHEL DR
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1456
Mailing Address - Country:US
Mailing Address - Phone:815-939-1900
Mailing Address - Fax:815-939-1902
Practice Address - Street 1:183 E BETHEL DR
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1456
Practice Address - Country:US
Practice Address - Phone:815-939-1900
Practice Address - Fax:815-939-1902
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490109601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical