Provider Demographics
NPI:1356895361
Name:DAWSON, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DAWSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 E 61ST ST
Mailing Address - Street 2:121
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-2384
Mailing Address - Country:US
Mailing Address - Phone:574-612-3007
Mailing Address - Fax:
Practice Address - Street 1:2625 FOXPOINTE DRIVE
Practice Address - Street 2:A
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203
Practice Address - Country:US
Practice Address - Phone:812-314-2378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46003014A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist