Provider Demographics
NPI:1518550904
Name:WARREN, DAWN D (MA 61107914)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:D
Last Name:WARREN
Suffix:
Gender:F
Credentials:MA 61107914
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3335 MARTIN WAY E APT 404
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-4947
Mailing Address - Country:US
Mailing Address - Phone:360-888-3672
Mailing Address - Fax:
Practice Address - Street 1:3435 MARTIN WAY E STE F
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5071
Practice Address - Country:US
Practice Address - Phone:360-485-0702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-16
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61107914225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist