Provider Demographics
NPI:1770835175
Name:STAPLETON, DAWN (CCC-A, FAAA)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:STAPLETON
Suffix:
Gender:F
Credentials:CCC-A, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 461207
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-1207
Mailing Address - Country:US
Mailing Address - Phone:402-343-4328
Mailing Address - Fax:402-343-4389
Practice Address - Street 1:17030 LAKESIDE HILLS PLZ STE 204
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2396
Practice Address - Country:US
Practice Address - Phone:402-758-5600
Practice Address - Fax:402-758-5169
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
098684Medicare Oscar/Certification