Provider Demographics
NPI:1942332952
Name:BIRTWELL, DAWN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:
Last Name:BIRTWELL
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 E VIA MERCADO
Mailing Address - Street 2:
Mailing Address - City:HUACHUCA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85616-9771
Mailing Address - Country:US
Mailing Address - Phone:800-850-0991
Mailing Address - Fax:815-301-8374
Practice Address - Street 1:165 E VIA MERCADO
Practice Address - Street 2:
Practice Address - City:HUACHUCA CITY
Practice Address - State:AZ
Practice Address - Zip Code:85616
Practice Address - Country:US
Practice Address - Phone:520-266-0991
Practice Address - Fax:815-301-8374
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP4292235Z00000X
MA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ868169Medicaid
MA1533037Medicaid