Provider Demographics
NPI:1013091750
Name:LEVITAN, DAWN RENEE (MS, EDD, LCPC)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:RENEE
Last Name:LEVITAN
Suffix:
Gender:F
Credentials:MS, EDD, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3517 BRABERRY LN
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60012-2079
Mailing Address - Country:US
Mailing Address - Phone:815-342-3726
Mailing Address - Fax:
Practice Address - Street 1:405 E CONGRESS PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6266
Practice Address - Country:US
Practice Address - Phone:815-342-3726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral