Provider Demographics
NPI:1811618929
Name:BROSE-STOWE, DAWN C (LMSW-42332)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:C
Last Name:BROSE-STOWE
Suffix:
Gender:F
Credentials:LMSW-42332
Other - Prefix:MRS
Other - First Name:DAWN
Other - Middle Name:CHRISTINE
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12192 N PINETREE RD
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-8401
Mailing Address - Country:US
Mailing Address - Phone:208-641-9159
Mailing Address - Fax:
Practice Address - Street 1:7905 N MEADOWLARK WAY STE B
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-5041
Practice Address - Country:US
Practice Address - Phone:208-772-3116
Practice Address - Fax:208-772-7677
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-42332104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker