Active NPI
Dawn Marie Boettger Mudd
- Counselor
- Lombard, IL
National Provider Identifier
1053664276
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 178007503
- Practice address
- 10 E 22ND St
Suite 101
Lombard, IL 60148-4977 - Phone
- (630) 627-5000
- Fax
- (630) 627-5032
- NPI assigned
- Oct 25, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 178007503 | IL | Primary |
Addresses
Primary practice location
10 E 22ND St
Suite 101
Lombard, IL 60148-4977
Mailing address
920 N Main St
Naperville, IL 60563-2632
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178007503 | IL | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1351123200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1351123200000",
"number": "1053664276",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "920 N MAIN ST",
"city": "NAPERVILLE",
"state": "IL",
"postal_code": "605632632"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 E 22ND ST",
"address_2": "SUITE 101",
"city": "LOMBARD",
"state": "IL",
"postal_code": "601484977",
"telephone_number": "630-627-5000",
"fax_number": "630-627-5032"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOETTGER MUDD",
"first_name": "DAWN",
"middle_name": "MARIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-10-25",
"last_updated": "2012-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "IL",
"license": "178007503",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lombard, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.