Healthcare Provider Details

I. General information

NPI: 1083757082
Provider Name (Legal Business Name): JUDITH R DALE R.N., C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 NE IRVING ST SUITE 250
PORTLAND OR
97232-2243
US

IV. Provider business mailing address

2298 SE DARLING AVE
GRESHAM OR
97080-5387
US

V. Phone/Fax

Practice location:
  • Phone: 503-233-4356
  • Fax:
Mailing address:
  • Phone: 503-661-1866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: