Healthcare Provider Details

I. General information

NPI: 1841959889
Provider Name (Legal Business Name): DOMINICA DALYNN MACDONALD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2021
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4585 SW 185TH AVE
ALOHA OR
97078-1557
US

IV. Provider business mailing address

4585 SW 185TH AVE
ALOHA OR
97078-1557
US

V. Phone/Fax

Practice location:
  • Phone: 150-359-1928
  • Fax: 503-848-2072
Mailing address:
  • Phone: 150-359-1928
  • Fax: 503-848-2072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: