Provider Demographics
NPI:1427447325
Name:PRIEST, DAWN RENEE (LISW)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:RENEE
Last Name:PRIEST
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:RENEE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14 MARCIA DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-1120
Mailing Address - Country:US
Mailing Address - Phone:740-627-0963
Mailing Address - Fax:
Practice Address - Street 1:11660 UPPER GILCHRIST RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-9084
Practice Address - Country:US
Practice Address - Phone:740-399-8008
Practice Address - Fax:740-399-8012
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-15
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.20022491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0200008Medicaid