Provider Demographics
NPI:1992938518
Name:SLY, DAWN (LCSW)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:SLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 898
Mailing Address - Street 2:
Mailing Address - City:CRESWELL
Mailing Address - State:OR
Mailing Address - Zip Code:97426-0898
Mailing Address - Country:US
Mailing Address - Phone:541-270-4660
Mailing Address - Fax:541-895-0977
Practice Address - Street 1:122 NE 47TH ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-1429
Practice Address - Country:US
Practice Address - Phone:541-270-4660
Practice Address - Fax:541-895-0977
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-30
Last Update Date:2009-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical