Provider Demographics
NPI:1194432666
Name:DAWSON, SUSAN (DOO)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:DAWSON
Suffix:
Gender:F
Credentials:DOO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3295 ROHRER RD
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-8313
Mailing Address - Country:US
Mailing Address - Phone:440-610-3504
Mailing Address - Fax:
Practice Address - Street 1:3295 ROHRER RD
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-8313
Practice Address - Country:US
Practice Address - Phone:440-610-3504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4946006320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities