Provider Demographics
NPI:1972565992
Name:SIMONE, DAWN H (PHD)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:H
Last Name:SIMONE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:SIMONE
Other - Last Name:DOOLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LP
Mailing Address - Street 1:3033 EXCELSIOR BLVD
Mailing Address - Street 2:SUITE 590
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4688
Mailing Address - Country:US
Mailing Address - Phone:612-225-6990
Mailing Address - Fax:612-225-6994
Practice Address - Street 1:3033 EXCELSIOR BLVD
Practice Address - Street 2:SUITE 590
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-4688
Practice Address - Country:US
Practice Address - Phone:612-225-6990
Practice Address - Fax:612-225-6994
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0716103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OTH000Medicare UPIN