Provider Demographics
NPI:1457575060
Name:VAGLE, DAWN (MA, DMIN)
Entity type:Individual
Prefix:DR
First Name:DAWN
Middle Name:
Last Name:VAGLE
Suffix:
Gender:F
Credentials:MA, DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 PINE LAKE CT
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-6496
Mailing Address - Country:US
Mailing Address - Phone:517-437-3777
Mailing Address - Fax:
Practice Address - Street 1:446 PINE LAKE CT
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-6496
Practice Address - Country:US
Practice Address - Phone:517-437-3777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401003550101YP2500X
MI68010646461041C0700X
MI4101005366106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist