Provider Demographics
NPI:1639857758
Name:DAWSON, ALEXANDRA K (DODD CMT)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:K
Last Name:DAWSON
Suffix:
Gender:F
Credentials:DODD CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 W RAVENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44511-3232
Mailing Address - Country:US
Mailing Address - Phone:234-716-3145
Mailing Address - Fax:
Practice Address - Street 1:610 W RAVENWOOD AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44511-3232
Practice Address - Country:US
Practice Address - Phone:234-716-3145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRT988170172A00000X
OH172V00000X, 251E00000X, 253Z00000X, 374U00000X, 332U00000X
OHW5C2G6J3146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No172A00000XOther Service ProvidersDriver
No172V00000XOther Service ProvidersCommunity Health Worker
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No374U00000XNursing Service Related ProvidersHome Health Aide
No332U00000XSuppliersHome Delivered Meals