Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 0054 | OR |
NPI | 1003189531 |
---|---|
Provider Name | Dawn Edwards |
First Address | Springfield, OR 97477-7948 |
Second Address | Springfield, OR 97477-7948 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2012 |
Last Update Date | 14/02/2012 |