Provider Demographics
NPI:1992410153
Name:JEZUIT, DAWN ASHLEY (LMHC-A, LAC-A, MA)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:ASHLEY
Last Name:JEZUIT
Suffix:
Gender:F
Credentials:LMHC-A, LAC-A, MA
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:
Other - Last Name:JEZUIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10220 WICKER AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-8400
Mailing Address - Country:US
Mailing Address - Phone:000-000-0000
Mailing Address - Fax:
Practice Address - Street 1:10220 WICKER AVE STE 3
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-8400
Practice Address - Country:US
Practice Address - Phone:000-000-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99114903A101YA0400X
IN88001773A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)