Provider Demographics
NPI:1750555686
Name:BOOTH, DAWN (CCC-A)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:BOOTH
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 N GREEN ACRES RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-2807
Mailing Address - Country:US
Mailing Address - Phone:479-587-0088
Mailing Address - Fax:479-444-9722
Practice Address - Street 1:2100 N GREEN ACRES RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-2807
Practice Address - Country:US
Practice Address - Phone:479-587-0088
Practice Address - Fax:479-444-9722
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA-224237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter