Healthcare Provider Details

I. General information

NPI: 1689713117
Provider Name (Legal Business Name): JOHN LOUIS DUGAN CADC1
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 SE 3RD AVE SUITE 100
HILLSBORO OR
97123-4093
US

IV. Provider business mailing address

3203 SE VINEYARD RD #29
MILWAUKIE OR
97267-4706
US

V. Phone/Fax

Practice location:
  • Phone: 503-693-3104
  • Fax: 503-693-6474
Mailing address:
  • Phone: 503-260-2614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number05-03-11
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: