Basic Information
| Provider Information | |||||||||
| NPI: | 1144353368 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | DAWN | ||||||||
| MiddleName: | KINNEY | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW, LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 718 GRIFFIN AVE # 133 | ||||||||
| Address2: | |||||||||
| City: | ENUMCLAW | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980223418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5953598100 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 39507 302ND AVE SE | ||||||||
| Address2: | |||||||||
| City: | ENUMCLAW | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980227798 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5593598100 | ||||||||
| FaxNumber: | 5597933542 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2007 | ||||||||
| LastUpdateDate: | 07/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCS 18193 | CA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | LCS18193 | CA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | LW60540457 | WA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.