Provider Demographics
NPI:1699355529
Name:DAWSON, RACHAEL EMILY (LEP)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:EMILY
Last Name:DAWSON
Suffix:
Gender:F
Credentials:LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9218 WICHITA DR
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77571-4421
Mailing Address - Country:US
Mailing Address - Phone:469-233-2832
Mailing Address - Fax:
Practice Address - Street 1:533 AIRPORT BLVD STE 400
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-2013
Practice Address - Country:US
Practice Address - Phone:650-590-9601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4066103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool