Doctor Name: | DAWN MARIE BOETTGER MUDD |
NPI Number: | 1053664276 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 178007503 |
Business Practice Address: | 10 E 22nd St Suite 101 Lombard, IL - 601484977 |
Business Phone Number: | 6306275000 |
Business Fax Number: | 6306275032 |
Mailing Address: | 920 N Main St, NAPERVILLE |
State: | IL |
Postal Code: | 605632632 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 10/25/2012 |
NPI Last Update Date: | 10/25/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | 178007503 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |