Provider Demographics
NPI:1811260045
Name:ENDERLE, DAWN (CD(DONA))
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:
Last Name:ENDERLE
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 639561
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-9561
Mailing Address - Country:US
Mailing Address - Phone:844-247-7222
Mailing Address - Fax:847-584-2604
Practice Address - Street 1:43334 7 MILE RD STE 200
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-2249
Practice Address - Country:US
Practice Address - Phone:844-247-7222
Practice Address - Fax:847-584-2604
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-19
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRBT-21-160490106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician