Provider Demographics
NPI:1740558592
Name:WITCRAFT, DAWN
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:WITCRAFT
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 1:1720 S CLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-2129
Mailing Address - Country:US
Mailing Address - Phone:605-334-5630
Mailing Address - Fax:605-332-5327
Practice Address - Street 1:1000 2ND ST S
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:MN
Practice Address - Zip Code:56081-1826
Practice Address - Country:US
Practice Address - Phone:507-375-3286
Practice Address - Fax:507-375-3288
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7760235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist