Provider Demographics
NPI:1649393091
Name:BASS, DAWN MARIE (AUD)
Entity type:Individual
Prefix:DR
First Name:DAWN
Middle Name:MARIE
Last Name:BASS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:IN
Mailing Address - Zip Code:46567-1120
Mailing Address - Country:US
Mailing Address - Phone:574-457-5050
Mailing Address - Fax:574-457-3668
Practice Address - Street 1:111 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:IN
Practice Address - Zip Code:46567-1120
Practice Address - Country:US
Practice Address - Phone:574-457-5050
Practice Address - Fax:574-457-3668
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002373A231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN224020BMedicare ID - Type Unspecified