Basic Information
| Provider Information | |||||||||
| NPI: | 1891824280 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOUAOUAD | ||||||||
| FirstName: | DAWN | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MA LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 610 S BURDICK ST | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490075221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693813700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 610 S BURDICK ST | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490075221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693813700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TP2701X | L993381 | MI | Y | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy |
No ID Information.