Provider Demographics
NPI:1053554923
Name:DAWSON, JENNIFER EILEEN
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:EILEEN
Last Name:DAWSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 MCDERMOTT DR
Mailing Address - Street 2:#214
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19383-0001
Mailing Address - Country:US
Mailing Address - Phone:610-430-5678
Mailing Address - Fax:
Practice Address - Street 1:1160 MCDERMOTT DR
Practice Address - Street 2:#214
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19383-0001
Practice Address - Country:US
Practice Address - Phone:610-430-5678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016022103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical