Provider Demographics
NPI:1740319631
Name:DAWGERT, GRACE MARIE (MA)
Entity type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:MARIE
Last Name:DAWGERT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 WOODLAND WAY
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-2714
Mailing Address - Country:US
Mailing Address - Phone:570-587-5437
Mailing Address - Fax:570-346-7450
Practice Address - Street 1:920 VIEWMONT DRIVE
Practice Address - Street 2:
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18519
Practice Address - Country:US
Practice Address - Phone:570-587-5437
Practice Address - Fax:570-346-7450
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
075899OtherFIRST PRIORITY
5295529OtherAETNA
769295OtherHIMARK BLUE CROSS SHIELD
001683790001OtherDEPT OF MEDICAL ASSISTANC
769295OtherCAPITOL BLUESHIELD
1215OtherGEISINGER HEALTH PLAN