Provider Demographics
NPI:1679121347
Name:JECKELL, DAWN M (BC-HIS)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:M
Last Name:JECKELL
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10775 REYNARD FOX LN
Mailing Address - Street 2:
Mailing Address - City:BEALETON
Mailing Address - State:VA
Mailing Address - Zip Code:22712-6852
Mailing Address - Country:US
Mailing Address - Phone:540-316-8194
Mailing Address - Fax:
Practice Address - Street 1:493 BLACKWELL RD STE 311
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2628
Practice Address - Country:US
Practice Address - Phone:540-341-7112
Practice Address - Fax:540-341-8361
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101002051237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist