Provider Demographics
NPI:1922239607
Name:LEE, DAWN MARIE (CDP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:LEE
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4914 WILDLIFE ACRES LN
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-7828
Mailing Address - Country:US
Mailing Address - Phone:360-391-2988
Mailing Address - Fax:
Practice Address - Street 1:17337 RESERVATION ROAD
Practice Address - Street 2:
Practice Address - City:LACONNER
Practice Address - State:WA
Practice Address - Zip Code:98257-8802
Practice Address - Country:US
Practice Address - Phone:360-466-7273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP 00004174101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1995216Medicaid