Provider Demographics
NPI:1740939206
Name:DAWTYNE, MARY GRACE (LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:GRACE
Last Name:DAWTYNE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:GRACE
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:403 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-3187
Mailing Address - Country:US
Mailing Address - Phone:815-285-5638
Mailing Address - Fax:
Practice Address - Street 1:403 E 1ST ST
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-3187
Practice Address - Country:US
Practice Address - Phone:815-285-5638
Practice Address - Fax:815-285-5850
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0243331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical