Provider Demographics
NPI:1528145083
Name:DAWSON, JOY HERREID (PHD LICENSED PSYCHOL)
Entity type:Individual
Prefix:DR
First Name:JOY
Middle Name:HERREID
Last Name:DAWSON
Suffix:
Gender:F
Credentials:PHD LICENSED PSYCHOL
Other - Prefix:DR
Other - First Name:JOY
Other - Middle Name:HERREID
Other - Last Name:VINEYARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD LICENSED PSYCHOL
Mailing Address - Street 1:102 ELM ST
Mailing Address - Street 2:
Mailing Address - City:LUVERNE
Mailing Address - State:MN
Mailing Address - Zip Code:56156-2111
Mailing Address - Country:US
Mailing Address - Phone:605-271-2796
Mailing Address - Fax:
Practice Address - Street 1:130 DAKOTA ST S
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:MN
Practice Address - Zip Code:56186
Practice Address - Country:US
Practice Address - Phone:507-777-4321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1138103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD46251OtherSIOUX VALLEY HEALTH PLAN
MN552252800Medicaid
MN2046901OtherPREFERRED ONE
MN114613OtherU CARE OF MN
3K682VIOtherBCBS MN
MN29000078Medicare ID - Type Unspecified