Provider Demographics
NPI:1699817593
Name:MEYER, DAWN HENDERSON
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:HENDERSON
Last Name:MEYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 SPLENDOR CT
Mailing Address - Street 2:
Mailing Address - City:STILLMAN VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61084-9007
Mailing Address - Country:US
Mailing Address - Phone:815-298-9470
Mailing Address - Fax:
Practice Address - Street 1:300 WASHINGTON STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:OREGON
Practice Address - State:IL
Practice Address - Zip Code:61061-1609
Practice Address - Country:US
Practice Address - Phone:815-298-9470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0126851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical