Provider Demographics
NPI:1841454766
Name:MCCOLLOM, DAWN HEATHER (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:HEATHER
Last Name:MCCOLLOM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:DAWN
Other - Middle Name:HEATHER
Other - Last Name:MILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1802 N DIVISION ST
Mailing Address - Street 2:SUITE 604
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-1182
Mailing Address - Country:US
Mailing Address - Phone:815-941-3882
Mailing Address - Fax:815-941-3884
Practice Address - Street 1:601 W NORRIS DR
Practice Address - Street 2:SUITE B
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-1381
Practice Address - Country:US
Practice Address - Phone:815-433-5101
Practice Address - Fax:815-433-5102
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2012-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0121971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical