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Individual
DAWN LYNETTE BACKER
Active
Individual
DAWN LYNETTE BACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CLVT
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
4490
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1174785992
—
SD
Enumeration date
07/18/2008
Last updated
07/18/2008
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