1902936636 NPI number — MRS. DAWN MARIE ZYWIEC LCPC RN

Table of content: MRS. DAWN MARIE ZYWIEC LCPC RN (NPI 1902936636)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902936636 NPI number — MRS. DAWN MARIE ZYWIEC LCPC RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZYWIEC
Provider First Name:
DAWN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCPC RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PLESHA
Provider Other First Name:
DAWN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1902936636
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1505 EASTLAND DRIVE
Provider Second Line Business Mailing Address:
LL 1000 EASTLAND PSYCHOLOGICAL SERVICES LTD
Provider Business Mailing Address City Name:
BLOOMINGTON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-663-1623
Provider Business Mailing Address Fax Number:
309-663-2310

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1505 EASTLAND DRIVE
Provider Second Line Business Practice Location Address:
LL 1000 EASTLAND PSYCHOLOGICAL SERVICES LTD
Provider Business Practice Location Address City Name:
BLOOMINGTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-663-1623
Provider Business Practice Location Address Fax Number:
309-663-2310
Provider Enumeration Date:
03/06/2007

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: 101YP2500X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 163W00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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