Provider Demographics
NPI:1689136335
Name:DUMOND, JAN N (MHC)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:N
Last Name:DUMOND
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:JANINE
Other - Middle Name:M
Other - Last Name:DUMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1441 W CENTRAL PARK AVE
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804-1707
Mailing Address - Country:US
Mailing Address - Phone:563-327-0757
Mailing Address - Fax:563-388-1041
Practice Address - Street 1:2711 W 63RD ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-1647
Practice Address - Country:US
Practice Address - Phone:563-327-0757
Practice Address - Fax:563-388-1041
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA087465101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health