Provider Demographics
NPI:1992178008
Name:NORTHERN, DAWN MARIE (MA)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:NORTHERN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 HOSPITAL RD
Mailing Address - Street 2:PO BOX 4067
Mailing Address - City:WAYNESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65583-2634
Mailing Address - Country:US
Mailing Address - Phone:573-774-5353
Mailing Address - Fax:573-774-2907
Practice Address - Street 1:1000 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65583-2634
Practice Address - Country:US
Practice Address - Phone:573-774-5353
Practice Address - Fax:573-774-2907
Is Sole Proprietor?:No
Enumeration Date:2015-11-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health