Provider Demographics
NPI:1902936636
Name:ZYWIEC, DAWN MARIE (LCPC RN)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:MARIE
Last Name:ZYWIEC
Suffix:
Gender:F
Credentials:LCPC RN
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:MARIE
Other - Last Name:PLESHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1505 EASTLAND DRIVE
Mailing Address - Street 2:LL 1000 EASTLAND PSYCHOLOGICAL SERVICES LTD
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701
Mailing Address - Country:US
Mailing Address - Phone:309-663-1623
Mailing Address - Fax:309-663-2310
Practice Address - Street 1:1505 EASTLAND DRIVE
Practice Address - Street 2:LL 1000 EASTLAND PSYCHOLOGICAL SERVICES LTD
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701
Practice Address - Country:US
Practice Address - Phone:309-663-1623
Practice Address - Fax:309-663-2310
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered163W00000XNursing Service ProvidersRegistered Nurse