Provider Demographics
NPI:1144353368
Name:MILLER, DAWN KINNEY (LCSW, LICSW)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:KINNEY
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 GRIFFIN AVE # 133
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-3418
Mailing Address - Country:US
Mailing Address - Phone:595-359-8100
Mailing Address - Fax:
Practice Address - Street 1:39507 302ND AVE SE
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-7798
Practice Address - Country:US
Practice Address - Phone:559-359-8100
Practice Address - Fax:559-793-3542
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 181931041C0700X
CALCS181931041C0700X
WALW605404571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical