Provider Demographics
NPI:1306434204
Name:HARRIS, DYON (LMSW)
Entity type:Individual
Prefix:MS
First Name:DYON
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 VILLAGE STATION LN
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-2427
Mailing Address - Country:US
Mailing Address - Phone:773-557-0606
Mailing Address - Fax:
Practice Address - Street 1:77 VILLAGE STATION LN
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-2427
Practice Address - Country:US
Practice Address - Phone:773-557-0606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64152104100000X
IL150102367104100000X
IL149.0230301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker