Provider Demographics
NPI:1174989933
Name:WALCOTT, DAWN RENEE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:RENEE
Last Name:WALCOTT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 N EVERGREEN DR NE STE 301
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9334
Mailing Address - Country:US
Mailing Address - Phone:616-364-1500
Mailing Address - Fax:616-364-6400
Practice Address - Street 1:3225 N EVERGREEN DR NE STE 301
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-9334
Practice Address - Country:US
Practice Address - Phone:616-364-1500
Practice Address - Fax:616-364-6400
Is Sole Proprietor?:No
Enumeration Date:2016-01-10
Last Update Date:2016-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010910111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical