Provider Demographics
NPI:1831336551
Name:MERYDITH, DAWN (LICSW)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:MERYDITH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 NE 91ST ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-3329
Mailing Address - Country:US
Mailing Address - Phone:206-765-7549
Mailing Address - Fax:
Practice Address - Street 1:2345 NE 91ST ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-3329
Practice Address - Country:US
Practice Address - Phone:206-765-7549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-16
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0072061041C0700X
WALW 602889381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA107314000OtherIOWA PLAN