Provider Demographics
NPI:1316517998
Name:CANNON, DWYN TERRICE
Entity type:Individual
Prefix:
First Name:DWYN
Middle Name:TERRICE
Last Name:CANNON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14200 PEAR TREE LN APT 41
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-2518
Mailing Address - Country:US
Mailing Address - Phone:240-918-0709
Mailing Address - Fax:
Practice Address - Street 1:635 EDGEWOOD ST NE APT 718
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-4133
Practice Address - Country:US
Practice Address - Phone:202-722-0502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant