Dawn M Harris, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.022001 Issued in IL

Practice address

580 Sycamore St
Marseilles, IL 61341-1366

Phone

(815) 795-2122

Fax

(815) 795-3507

NPI assigned

Jul 28, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dawn Mangan Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: dawn.harris@direct-address.org

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1595894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595894400000",
    "number": "1093324865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 SCHOOL ST STE A",
            "city": "MORRIS",
            "state": "IL",
            "postal_code": "604501207",
            "telephone_number": "815-941-9124",
            "fax_number": "815-941-4363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "580 SYCAMORE ST",
            "city": "MARSEILLES",
            "state": "IL",
            "postal_code": "613411366",
            "telephone_number": "815-795-2122",
            "fax_number": "815-795-3507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "DAWN",
        "middle_name": "M",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-28",
        "last_updated": "2020-07-28",
        "certification_date": "2020-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.022001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL LICENSE",
            "identifier": "149.022001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DAWN",
            "last_name": "MANGAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ryan Samonte Fortes, PHYSICAL THERAPIST
• James Barry Gallai, MD
• Goldwater Care Marseilles LLC
• Goldwater Care Marseilles LLC
• Mark Anthony Gualandri, RPH PHARMD
• Illinois State Surgical Assistants Inc
• Janet Beck Jakupcak, M.D.
• Laurie Sue Jeppson, M.S. CCC-SLP/L
• Kornelia G. Juergensen, MD, PHD, ABFP
• Danielle Kramer, M.S. CCC-SLP

• Clinical Social Worker in Marseilles, IL
• Providers in Marseilles, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.