Provider Demographics
NPI:1891824280
Name:BOUAOUAD, DAWN ANNE (MA LLP)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:ANNE
Last Name:BOUAOUAD
Suffix:
Gender:F
Credentials:MA LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4029 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-2763
Mailing Address - Country:US
Mailing Address - Phone:269-271-5613
Mailing Address - Fax:
Practice Address - Street 1:3437 KENBROOKE CT BLDG 12
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-5434
Practice Address - Country:US
Practice Address - Phone:269-271-5613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL993381103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy