Individual
DAWN LESLEY ETZEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1747 N WELLS ST, FORT WAYNE, IN 46808-3235
(260) 420-6100
(574) 268-2377
Mailing address
1747 N WELLS ST, FORT WAYNE, IN 46808-3235
(260) 420-6100
(574) 268-2377
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
86000311A
IN
101YM0800X
Mental Health Counselor
Primary
39002304A
IN
Other
Enumeration date
08/20/2010
Last updated
04/09/2024
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