Provider Demographics
NPI:1063581155
Name:IDEKER, DAWN MARIE (LMHC)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:MARIE
Last Name:IDEKER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24230 NOOKACHAMP HILLS DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-9196
Mailing Address - Country:US
Mailing Address - Phone:360-770-5476
Mailing Address - Fax:360-336-3270
Practice Address - Street 1:404 S 1ST ST
Practice Address - Street 2:SUITE 203
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-3866
Practice Address - Country:US
Practice Address - Phone:360-770-5476
Practice Address - Fax:360-336-3270
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60305329101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health