Provider Demographics
NPI:1588092894
Name:KUSINSKI, DAWN MARIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:DAWN
Middle Name:MARIE
Last Name:KUSINSKI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19235 WOLF RD STE 140
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-2062
Mailing Address - Country:US
Mailing Address - Phone:815-333-4032
Mailing Address - Fax:
Practice Address - Street 1:19235 WOLF RD STE 140
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-2062
Practice Address - Country:US
Practice Address - Phone:815-333-4032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180010105101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL47-2918608OtherPRIVATE PRACTICE OFFICE