1447565031 NPI number — DAWN THEREASA BIRCHENOUGH MA, LISW

Table of content: DAWN THEREASA BIRCHENOUGH MA, LISW (NPI 1447565031)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447565031 NPI number — DAWN THEREASA BIRCHENOUGH MA, LISW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIRCHENOUGH
Provider First Name:
DAWN
Provider Middle Name:
THEREASA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LISW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CORTEZ MCKEE
Provider Other First Name:
DAWN
Provider Other Middle Name:
T
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, LSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447565031
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
221 W LIBERTY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEDINA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44256-2217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-722-4166
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1622 E TURKEYFOOT LAKE RD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AKRON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44312-5277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-543-5015
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/08/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  I.1800904 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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