Provider Demographics
NPI:1679645253
Name:DAWN, JANIS RAYANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JANIS
Middle Name:RAYANN
Last Name:DAWN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MRS
Other - First Name:JANIS
Other - Middle Name:RAYANN
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:8045 E PORTOBELLO AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-1690
Mailing Address - Country:US
Mailing Address - Phone:480-507-1404
Mailing Address - Fax:480-507-1666
Practice Address - Street 1:8045 E PORTOBELLO AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-1690
Practice Address - Country:US
Practice Address - Phone:480-507-1404
Practice Address - Fax:480-507-1666
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPL4049235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist