Provider Demographics
NPI:1669094025
Name:DAWSON, SPENCER CHARLES (PHD)
Entity type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:CHARLES
Last Name:DAWSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 N BLUE SLOPES DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-1022
Mailing Address - Country:US
Mailing Address - Phone:812-269-2433
Mailing Address - Fax:
Practice Address - Street 1:1101 E 10TH ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47405-7007
Practice Address - Country:US
Practice Address - Phone:812-856-1901
Practice Address - Fax:812-856-4544
Is Sole Proprietor?:No
Enumeration Date:2020-05-08
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TH0100X, 173F00000X, 103TB0200X, 103TH0004X
IN20043352A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No173F00000XOther Service ProvidersSleep Specialist, PhD
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth