Provider Demographics
NPI:1780564930
Name:DAWE, TRAVIS JOEL (CPS)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:JOEL
Last Name:DAWE
Suffix:
Gender:M
Credentials:CPS
Other - Prefix:
Other - First Name:TJ
Other - Middle Name:JOEL
Other - Last Name:DAWE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPS
Mailing Address - Street 1:1753 YONKEE AVE
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-2232
Mailing Address - Country:US
Mailing Address - Phone:682-999-0825
Mailing Address - Fax:307-207-8537
Practice Address - Street 1:1753 YONKEE AVE
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2232
Practice Address - Country:US
Practice Address - Phone:682-999-0825
Practice Address - Fax:307-207-8537
Is Sole Proprietor?:No
Enumeration Date:2025-09-06
Last Update Date:2025-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY179175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist