Provider Demographics
NPI:1447406293
Name:DAWLEY, CHARLIE VINCENT (LP)
Entity type:Individual
Prefix:MR
First Name:CHARLIE
Middle Name:VINCENT
Last Name:DAWLEY
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 382
Mailing Address - Street 2:
Mailing Address - City:STEWARTVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55976-0382
Mailing Address - Country:US
Mailing Address - Phone:507-254-2180
Mailing Address - Fax:
Practice Address - Street 1:205 7TH AVE SW
Practice Address - Street 2:
Practice Address - City:STEWARTVILLE
Practice Address - State:MN
Practice Address - Zip Code:55976-1127
Practice Address - Country:US
Practice Address - Phone:507-254-2180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1394103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist