Jamie Roshun Dawson
Individual provider Active NPI Contractor · Phoenix, AZ
NPI 1023637345 · NPPES record last updated Sep 11, 2020
Key facts
- NPI
- 1023637345
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- 10125986 (AZ)
- Practice address
- 13229 S 48TH St Apt 3051
Phoenix, AZ 85044 - Phone
- (501) 952-1976
- NPI assigned
- Apr 16, 2020
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10125986 | AZ | MD | Child Mental Illness Respite Care |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Child Mental Illness Respite Care | 385HR2055X | 10125986 | AZ | |
| Contractor | 171W00000X | 10125986 | AZ | Yes |
Addresses
Primary practice location
13229 S 48TH St Apt 3051
Phoenix, AZ 85044
Mailing address
Intermountain Centers for Human Development Inc.
PO Box 86537
Tuscon, AZ 85754-6537
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10125986 | Other | AZ | AZ DEPT OF HEALTH SERVICES |
| 1023637345 | Other | AZ | THERAPEUTIC FOSTER CARE |
Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 11, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.