Provider Demographics
NPI:1194880260
Name:POLCYN, DAWN M (EDS)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:M
Last Name:POLCYN
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:M
Other - Last Name:BAUGH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:701 WEST WETMORE RD. RM. 168
Mailing Address - Street 2:PIMA COUNTY AMPHITHEATER SCHOOS DBA AMPHITHEATER PUBLIC
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-1547
Mailing Address - Country:US
Mailing Address - Phone:520-696-5237
Mailing Address - Fax:520-696-5067
Practice Address - Street 1:701 WEST WETMORE RD. RM. 168
Practice Address - Street 2:AMPHITHEATER PUBLIC SCHOOLS
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-1547
Practice Address - Country:US
Practice Address - Phone:520-696-5237
Practice Address - Fax:520-696-5067
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TS0200X
AZ3772694103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ142953Medicaid