Provider Demographics
NPI:1023623584
Name:BATES, DAWN M (PHD)
Entity type:Individual
Prefix:DR
First Name:DAWN
Middle Name:M
Last Name:BATES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 HEINZ RD APT 9
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-7240
Mailing Address - Country:US
Mailing Address - Phone:734-478-3007
Mailing Address - Fax:
Practice Address - Street 1:2675 HEINZ RD APT 9
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-7240
Practice Address - Country:US
Practice Address - Phone:734-478-3007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA089357103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA105164OtherHEALTH SERVICE PROVIDER NUMBER