Provider Demographics
NPI:1174776132
Name:WISNIEWSKI-NELSON, DAWN K (BCABA)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:K
Last Name:WISNIEWSKI-NELSON
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4160 CENTRAL SARASOTA PKWY APT 621
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-6616
Mailing Address - Country:US
Mailing Address - Phone:941-536-6984
Mailing Address - Fax:
Practice Address - Street 1:4160 CENTRAL SARASOTA PKWY APT 621
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-6616
Practice Address - Country:US
Practice Address - Phone:941-536-6984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-08-2593103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst